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Case Reports
. 2018 Apr-Jun;13(2):407-410.
doi: 10.4103/ajns.AJNS_148_16.

Cerebrospinal Fluid Egress from the Quadripolar Deep Brain Stimulation Electrode for Anterior Nucleus of the Thalamus for Refractory Epilepsy

Byung-Chul Son  1   2 , Jin-Gyu Choi  1 , Sang-Woo Ha  3
Affiliations
Case Reports

Cerebrospinal Fluid Egress from the Quadripolar Deep Brain Stimulation Electrode for Anterior Nucleus of the Thalamus for Refractory Epilepsy

Byung-Chul Son et al. Asian J Neurosurg. 2018 Apr-Jun.

Abstract

Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is an effective treatment for refractory epilepsy. Due to the unique location of ANT in the thalamus facing the lateral and third ventricles, transventricular DBS lead placement is an essential part of ANT DBS. However, there is no report regarding hardware problems including impedance variability in transventricular ANT DBS due to limited experience. A 45-year-old male patient with previously effective, bilateral ANT DBS presented with increasing seizure frequency and a shortened battery longevity within 2 years. Magnetic resonance imaging showed that the left-sided DBS lead was in the third ventricle leaning on the medial wall of ANT. Electrode revision was performed. Upon disconnecting the proximal lead from the extension connection, cerebrospinal fluid egress through fine gaps between the metallic electrode contacts, and electrode spacing was observed. This case raises a concern about the transventricular approach for ANT lead placement because the currently available DBS electrode lead is not waterproofed. A careful, longitudinal follow-up of DBS impedance for ANT DBS is warranted.

Keywords: Anterior nucleus of the thalamus; cerebrospinal fluid; deep brain stimulation; electrode; epilepsy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Prerevision radiologic assessment of the patient. (a) An anterior–posterior projection of skull X-ray showing bilateral deep brain stimulation electrode placement for the anterior nucleus of the thalamus. An asymmetrical placement was noted. A T2-weighted axial (b) and coronal (c) magnetic resonance imaging showed that left-sided anterior nucleus of the thalamus deep brain stimulation lead leaning over the anterior nucleus of the thalamus (arrow) was located within the third ventricle
Figure 2
Figure 2
A photograph showing cerebrospinal fluid egress from the proximal end of quadripolar deep brain stimulation electrode lead. Cerebrospinal fluid egressing from fine gaps between the metallic electrode contacts and electrode spacing was observed
See this image and copyright information in PMC

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