gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Symptomatic but transient postoperative edema in the close surrounding of a deep brain stimulation (DBS) electrode

Meeting Abstract

  • Jan Walter - Klinik für Neurochirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena
  • Albrecht Günther - Klinik für Neurologie, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena
  • Christoph Redecker - Klinik für Neurologie, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena
  • Rupert Reichart - Klinik für Neurochirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena
  • Rolf Kalff - Klinik für Neurochirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 004

doi: 10.3205/14dgnc399, urn:nbn:de:0183-14dgnc3997

Published: May 13, 2014

© 2014 Walter et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Despite haemorrhages and infections, which are the most frequent postoperative complications after deep brain stimulation (DBS), symptomatic postoperative edema around a DBS lead is a very rare presentation. And it is particularly seldom reported as a separate entity being symptomatic, transient, and not due to infection. We aim to report a case and to discuss the morphological characteristics of postoperative edema around a DBS electrode with insights into possible etiologies and management.

Method: Case report and review of the current literature.

Results: A 66-year-old man with a history of advanced Parkinson’s disease (PD) was referred for the placement of bilateral subthalamic nucleus (STN) electrodes. The patient underwent the procedure under local anaesthesia and sedation. The burr holes were sealed with fibrin glue to minimize CFS loss. Microelectrode recording (MER) was performed using 4 parallel trajectories both on the right and left sides. After mapping of the anterior and lateral borders of the STN the permanent quadripolar lead (model 3389, Medtronic) was positioned, and programmable IPG (Actica PC, Medtronic) was implanted. Immediate postoperative CT scan confirmed precise lead placement and ruled out any abnormalities. 7 days after surgery, the patient developed slight confusion, a left sided gaze palsy and facioplegia. He had no fever and showed no signs of infection. CT scan revealed a new subcortical and thalamic hypodensity surrounding solely the right lead. Moreover MRI showed hyperintensity in FLAIR, T2, T2*, hypointensity in T1 without Gd enhancement. Since there was also no evidence of vascular processes and laboratory values were normal we assumed an idiopathic, postoperative edema around the right lead and introduced oral corticosteroids for 10 days. Antibiotics were not administered. Both, clinical symptoms and radiological imaging improved during the next two weeks.

Conclusions: Symptomatic but transient postoperative, non infectious edema surrounding a DBS electrode is an absolutely rare entity, described in only three papers before. The edema is generally unilateral even in bilateral procedures. The onset of clinical and radiological edema varies between few days to several weeks. The clinical outcome is usually satisfactory without any surgical intervention. Although the exact etiological mechanism underlying this phenomenon remains obscure, both an inappropriate immune reaction an edema as a complication of microhemorrhages have to be discussed.