Pneumocephalus after Deep Brain Stimulation

Symptomatic intraparenchymal pneumocephalus is a rare complication of DBS surgery which can be treated with surgical evacuation 1).


Better understanding of how pneumocephalus displaces subcortical structures can significantly enhance our intraoperative decision making and overall targeting strategy 2).


Postoperative pneumocephalus air must be considered as a possible complication of deep brain stimulation and should be on the list of differentials if a patient presents with post operative neurological deficit 3).


Data suggest that strict supine positioning during STN DBS surgery results in minimal intracranial air and is not associated with VAE or symptomatic intracranial hemorrhage when the operative method described is used 4).


The electrode positions in the immediate postoperative CT might have significant discrepancies with those in the CT taken at a stable period after STN DBS especially when there is a large amount of pneumocephalus 5).


Santos et al. published pneumocephalus with clinical repercussions in 3 cases 6).


1)
Albano L, Rohatgi P, Kashanian A, Bari A, Pouratian N. Symptomatic Pneumocephalus after Deep Brain Stimulation Surgery: Report of 2 Cases. Stereotact Funct Neurosurg. 2020 Feb 4:1-7. doi: 10.1159/000505078. [Epub ahead of print] PubMed PMID: 32018273.
2)
Matias CM, Frizon LA, Asfahan F, Uribe JD, Machado AG. Brain Shift and Pneumocephalus Assessment During Frame-Based Deep Brain Stimulation Implantation With Intraoperative Magnetic Resonance Imaging. Oper Neurosurg (Hagerstown). 2018 Jun 1;14(6):668-674. doi: 10.1093/ons/opx170. PubMed PMID: 28973421.
3)
Hussain MA, Jenkins A. Unusual complication after insertion of deep brain stimulator electrode. Br J Neurosurg. 2016 Sep 14:1. [Epub ahead of print] PubMed PMID: 27626831.
4)
Nazzaro JM, Lyons KE, Honea RA, Mayo MS, Cook-Wiens G, Harsha A, Burns JM, Pahwa R. Head positioning and risk of pneumocephalus, air embolism, and hemorrhage during subthalamic deep brain stimulation surgery. Acta Neurochir (Wien). 2010 Dec;152(12):2047-52. doi: 10.1007/s00701-010-0776-5. Epub 2010 Sep 23. Review. PubMed PMID: 20862499.
5)
Kim YH, Kim HJ, Kim C, Kim DG, Jeon BS, Paek SH. Comparison of electrode location between immediate postoperative day and 6 months after bilateral subthalamic nucleus deep brain stimulation. Acta Neurochir (Wien). 2010 Dec;152(12):2037-45. doi: 10.1007/s00701-010-0771-x. Epub 2010 Aug 19. PubMed PMID: 20721590.
6)
Santos P, Valero R, Arguis MJ, Carrero E, Salvador L, Rumià J, Valldeoriola F, Fàbregas N. [Preoperative adverse events during stereotactic microelectrode-guided deep brain surgery in Parkinson's disease]. Rev Esp Anestesiol Reanim. 2004 Nov;51(9):523-30. Spanish. PubMed PMID: 15620163.
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