Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb;46(2):761-768.
doi: 10.1007/s10072-024-07774-4. Epub 2024 Sep 19.

Risk factors and significance of post-operative edema in Parkinson Disease patients submitted to deep brain stimulation. A ten-year case series

Alessandro Izzo #  1 , Francesco Bove #  2 , Quintino Giorgio D'Alessandris  3   4 , Danilo Genovese  2 , Tommaso Tufo  1 , Manuela D'Ercole  1 , Giovanni Pennisi  1   5 , Federica Figà  1   5 , Marco Obersnel  1   5 , Valerio Perotti  5   6 , Maria Filomena Fuggetta  1 , Anna Rita Bentivoglio  2   5 , Paolo Calabresi  2   5 , Alessandro Olivi  1   5 , Carla Piano #  2   5 , Nicola Montano #  1   5
Affiliations

Risk factors and significance of post-operative edema in Parkinson Disease patients submitted to deep brain stimulation. A ten-year case series

Alessandro Izzo et al. Neurol Sci. 2025 Feb.

Abstract

Background: Peri-electrode edema after deep brain stimulation (DBS) surgery for Parkinson Disease (PD) has been reported in up to 100% of cases. The clinical significance of this finding is unclear, with most papers suggesting a benign course. The risk factors are also poorly defined. We aimed at defining the incidence rate, the clinical significance and the predictive factors of peri-electrode edema in patients undergoing DBS for PD.

Methods: We reviewed data of 119 patients treated with frameless stereotactic DBS for PD between 2012 and 2022 at our Institution. A mixed-technique targeting was adopted. Awake surgery was used in 64.7% cases; in most cases, microelectrode recording (MER) was adopted. The target was the subthalamic nucleus (STN) in 91.2% cases.

Results: Ninety patients were included. Postoperative edema related to lead placement was noticed in 40% patients after a median time of 2 days since surgery; in 88.9% of these cases, it was limited to subcortical white matter. Symptomatic edema was registered only in one case (1.1%), confirming previous reports on the benign clinical course. The only independent predictive factor for edema onset was asleep surgery (p = 0.0451). Notably, the use of directional electrodes was not associated with an increased risk of edema at multivariable analysis. Clinical parameters including age, and timing of CT scanning, did not affect edema onset.

Conclusions: We confirmed the very low rate of symptomatic edema in DBS for PD. When feasible, awake DBS using MER is the ideal technique to reduce the risk of radiologic postoperative edema.

Keywords: Asleep; Deep brain stimulation; Directional electrode; Edema; Microelectrode recording; Parkinson disease.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors have no relevant financial or non-financial interests to disclose. Ethics approval: The study was conducted according to the principles set forth in the Declaration of Helsinki and was approved by the Institutional Ethics Committee of Fondazione Policlinico Gemelli IRCCS (Prot. No. 4578). Consent to participate: informed consent was obtained from all individual participants included in the study.

References

    1. Ryu SI, Romanelli P, Heit G (2004) Asymptomatic transient MRI signal changes after unilateral deep brain stimulation electrode implantation for movement disorder. Stereotact Funct Neurosurg 82:65–69. 10.1159/000077402 - PubMed
    1. Moss J (2004) Electron microscopy of tissue adherent to explanted electrodes in dystonia and Parkinson’s disease. Brain 127:2755–2763. 10.1093/brain/awh292 - PubMed
    1. Englot DJ, Glastonbury CM, Larson PS (2011) Abnormal T2-weighted MRI signal surrounding leads in a subset of deep brain stimulation patients. Stereotact Funct Neurosurg 89:311–317. 10.1159/000329365 - PubMed
    1. Kim JW, Hwang JH, Kim IK et al (2013) Acute brain reaction to DBS electrodes after deep brain stimulation: chronological observation. Acta Neurochir (Wien) 155:2365–2371 discussion 2371. 10.1007/s00701-013-1853-3 - PubMed
    1. de Cuba CMKE, Albanese A, Antonini A et al (2016) Idiopathic delayed-onset edema surrounding deep brain stimulation leads: insights from a case series and systematic literature review. Parkinsonism Relat Disord 32:108–115. 10.1016/j.parkreldis.2016.09.007 - PubMed

LinkOut - more resources