Unveiling patterns of peri-lead edema after deep brain stimulation: a retrospective review of clinical and demographic factors.

Objective: Postoperative peri-lead edema (PLE) is an increasingly recognized complication of deep brain stimulation (DBS), a therapeutic intervention commonly used for neurological conditions such as Parkinson's disease (PD), essential tremor (ET), intractable focal epilepsy, and dystonia. In this study, we conducted a retrospective chart review to evaluate the incidence of PLE and explore potential clinical and demographic risk factors.

Methods: A single physician performed DBS electrode placements. To check for complications, postoperative computed tomography (CT) scans were conducted on the day of surgery and approximately 12-15 days afterward. Data on age, gender, complications, edema size, electrode laterality, lead target, lead brand, indication, and use of robotic assistance versus Starfix were collected and analyzed statistically.

Results: 133 leads were implanted in 63 patients, with peri-lead edema (PLE) observed in 65 electrodes (48.87%). Minor postoperative complications, such as subarachnoid hemorrhage (SAH) and subdural hematoma (SDH), were noted in some patients. A few cases of severe PLE were recorded, with the most significant volume of edema reaching 85.11 cm³. No statistically significant differences were found between PLE-positive and PLE-negative patients based on age, sex, lead target, indication, or robotic assistance versus Starfix. However, the use of Boston Scientific electrodes was significantly associated with PLE, with a p-value of 0.047. A logistic regression model (p = 0.013, R² = 0.219) correctly classified 63.2% of cases, with no significant predictors of PLE, but imaging complications (p = 0.057) and electrode brand (p = 0.086) approached significance, with Boston Scientific electrodes linked to higher PLE risk compared to Abbott electrodes (p = 0.027, OR = 3.729).

Conclusions: PLE appears more prevalent than previously reported and generally presents with delayed onset post-surgery. This retrospective analysis identified the use of Boston Scientific electrodes as a potential risk factor for PLE. Further research, particularly more extensive studies, is necessary to clarify the underlying mechanisms of PLE, improve prevention strategies, and enhance our understanding of this complication.