PMC9168029_01
Peri-lead edema 2 months after deep brain stimulation surgery. (A) Axial CT, (B) axial MRI T2. Cystic cavitation around the lead 4 months after deep brain stimulation surgery. (C) Axial CT, (D) axial MRI T2. Five months after deep brain stimulation surgery. (E) Coronal T2 (MRI) showing a large cyst, (F) axial T1 (MRI) the cystic cavitation with a maximum diameter of 34.9 mm.
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F1
T magnetic resonance imaging (MRI) were performed. The images revealed hypodensities or high signals surrounding the right lead, extending from the subcortical region to the deep white matter near the lateral ventricles (Figures 1A,B). In the fourth and fifth months after DBS, CT and 1.5T MRI of the brain revealed a right cystic cavity with a maximum diameter of 34.9 mm compatible with CSF in all sequences surrounding both leads and their contacts (Figures 1C-F).
(A) Stereotactic cyst puncture is performed (a: Brain puncture needle hole, b: previous electrode hole). (B) The clear cyst fluid will flow out automatically after the brain puncture needle into the cyst. (C) About 25 ml clear cyst fluid drained through stereotactic cyst aspiration.
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F2
Ultimately, about 25 mL of clear cyst fluid was drained (Figure 2).
(A) Axial CT 1 day after cyst aspiration demonstrates the cyst that have almost disappeared. (B) Axial CT 6 days after cyst aspiration. (C) Coronal T2 (MRI) 6 days after cyst aspiration. (D) Axial T2 (MRI) 6 days after cyst aspiration without displacement of the right lead.
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F3
The patient was discharged with significant improvement in her symptoms and continued tremor resolution, with ON-stimulation following surgery (Figure 3).
MRI following 5 month stereotactic aspiration demonstrated significant regression of the peri-lead edema and cystic cavitation. (A) Axial T1 (B) axial T2 (C) axial T2.
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F4
After a 5-month stereotactic aspiration, the patient was admitted for a 1.5T MRI in the OFF-stimulation state, demonstrating that peri-lead edema and cystic cavitation had significantly regressed without recurring (Figure 4).