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Microscopic Analysis at the Level of the Tip of the Deep Brain Stimulation Electrode. (A) The tip of the deep brain stimulation (DBS) lead was placed in the internal globus pallidus (GPi) and was confirmed by postmortem analysis. Progressive atrophy of the GPi resulted in the lead being much closer to the internal capsule (~1.3 mm) than would be predicted by microelectrode mapping and macrostimulation. (B) The tip of a DBS lead placed in the GPi confirmed using hematoxylin and eosin. Some gliosis and hemosiderin deposits are also seen. (C) Gliosis surrounding the tip of the DBS lead as demonstrated by glial fibrillary acidic protein immunohistochemistry. (D) A rim of meningothelial cells near the lead defect as seen by immunohistochemistry using epithelial membrane antigen.
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Postoperative images of the lead locations are shown in Figure 1.
Fusion of Magnetic Resonance and Computed Tomography Images Showing the Lead Locations at the Time of Deep Brain Stimulation Surgery. The deep brain stimulation lead was placed within the internal globus pallidus and was intended to be >2-3 mm away from the internal capsule. The physiology was confirmed by postoperative imaging.
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The distal lead tip defect of the DBS electrode was located 1.3 mm from the internal capsule (Figure 2A). There was remote gliosis at the distal tip of the DBS lead as supported by immunohistochemistry for GFAP (Figure 2B), and focal hemosiderin deposition (Figure 2-BH&E, Figure 2C, GFAP). In addition, the lead tip defect was surrounded with a "rim" of menigothelial/arachnoidal cells as confirmed by immunohistochemistry for epithelial membrane antigen (Figure 2D).