Objective: To describe the unexpected, beneficial effects of cyst formation as a complication of sub-thalamic nucleus (STN) deep brain stimulation (DBS) surgery in a patient with Parkinson’s disease (PD) and treatment refractory tremor.

Background: DBS is a very effective surgical intervention to improve motor function and tremor in appropriately selected patients with PD.  The most frequent complications of DBS surgery include infection, bleeding, seizures, and migration of leads.  CSF cyst formation is a relatively rare complication of DBS surgery, with only case-reports found in the literature.

Methods: Case Report

Results: A 59 y/o male with PD had a left STN deep brain stimulator placed for refractory right arm tremor.  Within a month of electrode placement and optimization of stimulation parameters, he had significant improvement in his right sided tremor.  Unfortunately, two months after his surgery, he developed new onset gait impairment, sensory symptoms involving the right face, and a predominantly expressive aphasia.  The DBS stimulation was turned off without any change in symptoms.  He underwent further evaluation, including a CT and MRI of the head with contrast.  The imaging revealed a cystic lesion at the tip of the DBS electrode in the left STN with no rim enhancement to suggest infection or hemorrhage.  His DBS electrode was subsequently removed with gradual improvement in the deficits but no return of tremor in the right arm.  He gradually developed worsening of his left sided PD symptoms over time which required treatment with antiparkinsonian medications but, to this date eight years later, the right sided tremor has not recurred.

Conclusions: This abstract demonstrates that the rare DBS complication of cyst formation after electrode placement in the STN for PD resulted in enduring control of tremor, despite removal of the electrode. The cyst formation may have acted as a permanent lesion to the STN, providing long-term symptomatic benefit.

References: 1.)  Jagid J, Madhavan K, Bregy A, Desai M, Ruiz A, Quencer R, Landy HJ. Deep brain stimulation complicated by bilateral large cystic cavitation around the leads in a patient with Parkinson’s disease. BMJ Case Rep. 2015 Oct 16;2015.

2.) Ramirez-Zamora A, Levine D, Sommer DB, Dalfino J, Novak P, Pilitsis JG. Intraparenchymal cyst development after deep brain stimulator placement.  Stereotact Funct Neurosurg. 2013;91(5):338-41.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-tremor-benefit-from-cyst-formation-as-a-complication-of-dbs-surgery-in-a-patient-with-parkinsons-disease/