Objective: To study post-operative imaging findings following deep brain stimulation (DBS) and to analyse their association with the patient`s clinical status.

Background: DBS is widely used for the treatment of movement disorders, including Parkinson’s disease, Essential tremor and Dystonia. Despite being a powerful therapeutic tool, it can uncommonly be associated with complications, such as intracranial haemorrhage, peri-electrode edema or infection. Neuroimaging plays a very important role in the evaluation of patients with implanted electrodes and is used to identify or exclude the presence of post-procedure complications.

Method: We performed a retrospective review of the post-operative imaging findings of brain computed tomography (CT) and magnetic resonance imaging (MRI) in patients submitted to DBS at Hospital de Santa Maria from 2008 to 2022. We considered eligible all patients that had the first post-operative imaging study performed within a week after surgery, and, for each patient, we collected the following data: age, sex, diagnosis, DBS target, imaging modality performed, imaging findings and clinical information. We did not include imaging examinations performed more than one month after the DBS procedure.

Results: The study included 284 patients: 220 with Parkinson’s disease (77%), 53 with dystonia (19%), 5 with essential tremor (2%) and 6 with Tourette’s syndrome (2%). Most imaging studies in the post-operative setting included CT scans performed as routine control (n=294), of which 275 (94%) were performed within the first 72 hours after the procedure and 19 (6%) between the 4^th and the 8^th day. Only a minority of the exams were done to evaluate complications. The most common imaging finding was pneumocephalus (n=206), always mild and asymptomatic. Other findings included peri-lead edema (n=13), in most cases reversible and better identified on MRI; intraparenchymal haemorrhage (n=6), which, although rare, was associated with clinical symptoms; and cerebral ischemia (n=1), a very rare finding.

Conclusion: Besides pneumocephalus, DBS complications depicted by brain imaging are rare, confirming the low risk of adverse effects of the procedure.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/post-operative-imaging-findings-in-deep-brain-stimulation/