Delayed clinical improvement after deep brain stimulation–related subdural hematoma

Report of 4 cases

Genko Oyama Departments of Neurology and

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 M.D., Ph.D.
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Michael S. Okun Departments of Neurology and
Neurosurgery, University of Florida Movement Disorders Center, Gainesville; and

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 M.D.
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Theresa A. Zesiewicz Department of Neurology, College of Medicine, University of South Florida Health, Tampa, Florida

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 M.D.
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Tiffany Tamse Departments of Neurology and

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Janet Romrell Departments of Neurology and

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Pamela Zeilman Departments of Neurology and

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Kelly D. Foote Neurosurgery, University of Florida Movement Disorders Center, Gainesville; and

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Page Range:
289–294
Volume/Issue:
Volume 115: Issue 2
DOI link:
https://doi.org/10.3171/2011.3.JNS101424
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Object

The purpose of this paper is to present 4 cases that illustrate the management and outcome of subdural hematoma (SDH) following deep brain stimulation (DBS) lead implantation.

Methods

The authors identified 4 cases of SDH following DBS lead implantation from a pool of 500 consecutive lead implantations (incidence 0.08%) performed at the University of Florida. Cases were characterized by chart review, serial Unified Parkinson's Disease Rating Scale evaluations, and changes on serial postoperative imaging studies.

Results

Two of the 4 patients with DBS-related SDH were clinically symptomatic. In the other 2 cases the SDH was incidentally discovered on routine postoperative lead localization imaging studies. None of the patients required craniotomy for evacuation of the SDH in the acute phase. Three of the 4 cases were managed with bur hole drainage in the chronic phase, and one was successfully managed nonoperatively. In all 4 cases, thresholds for stimulationinduced side effects were lower during initial postoperative programming than during intraoperative macrostimulation. Expected clinical improvement from DBS was achieved without lead revision in all 4 cases, but only after a significant delay.

Conclusions

Subdural hematoma is a rare and potentially avoidable complication of DBS that does not typically mandate acute hematoma evacuation or hardware revision and does not preclude an excellent outcome from DBS therapy. The clinical picture and apparent lead position tend to improve with time, and it may be wise to delay repositioning of an ineffective DBS lead following a hemorrhage until the DBS lead and surrounding brain tissue have settled into their final position and the insulted brain has had sufficient time to recover.

Abbreviations used in this paper:

DBS = deep brain stimulation; PD = Parkinson disease; SDH = subdural hematoma; STN = subthalamic nucleus; UPDRS = United Parkinson's Disease Rating Scale.
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Contributor Notes

Address correspondence to: Michael Okun, M.D., Department of Neurology, McKnight Brain Institute, 100 South Newell Drive, Room L3-101, Gainesville, Florida 32610. email: okun@neurology.ufl.edu.

Please include this information when citing this paper: published online April 8, 2011; DOI: 10.3171/2011.3.JNS101424.

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