PMC2695214_01
Early postoperative computed tomography scan documenting correct electrodes positioning.
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Four hours after surgery the patient underwent a control CT scan of the brain (Figure 1), documenting correct positioning of the stimulating electrodes.
Computed tomography scan taken after the patient's health deteoriated, documenting frontal intraparenchymal hematoma along the trajectory of the definitive electrode.
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One hour later, right hemiparesis and diminished level of consciousness were noticed, together with a severe dysarthria, and a further control CT scan was obtained: a 3 cm maximum diameter cortical-subcortical hematoma was documented, approximately 25 cc in volume, located in the frontal lobe along the electrode's trajectory, with a significant local mass-effect (Figure 2).
Maximum electrode displacement, as noted on the 13th postoperative day control computed tomography scan.
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At a CT scan performed eight days after STN-DBS, initial lateral displacement of the left electrode was noticed, and reached 8 mm lateral to the target as measured on the axial plane at a CT scan control performed during the 13th postoperative day (Figure 3).
Forty fifth postoperative day control computed tomography scan demonstrating return of the left definitive electrode to the original position.
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Centre for Neuroimaging, London, UK and Matlab 7.1; Mathworks Inc., Natick, MA, USA), applying roto-traslations to the CT voxels to obtain slices which were comparable to the pre-hematoma pictures (Figure 4). Comparison between the two exams documented return of the electrode to a position comparable to the immediate postoperative control.