The influence of pneumocephalus on electrode position following deep brain stimulation for Parkinson's disease
Objective To investigate the influence of pneumocephalus on electrode position following deep brain stimulation for Parkinson's disease.Methods A retrospective study was conducted on 78 patients with Parkinson's disease who underwent bilateral deep brain stimulation of the subthalamic nucleus between May 2021 and October 2022 at the Department of Neurosurgery,the Secondary Affiliated Hospital,Zhejiang University School of Medicine.Thin-slice CT scan was performed in the early(within 1 day)and late(1 month)postoperative periods respectively.The volume of pneumocephalus and the deviation between the electrode and the target were calculated.The coordinate difference between the early and late postoperative periods was calculated at an axial level 4 mm below the anterior and posterior commissure.X represented the lateral or medial distance to the AC(anterior commissure)-PC(posterior commissure)line(positive for the lateral and negative for the medial);Y represented the distance in the direction of AC-PC line(positive for the anterior and negative for the posterior).The deviation of the electrode position caused by the absorption of intracranial pneumocystis within 1 month after surgery was evaluated,and the correlation between intracranial pneumocephalus and the coordinate difference was analyzed.Results Median volume of pneumocephalus for a cohort of 78 patients was measured to be 1.08(0.22,3.02)cm3 in the early postoperative period,the median volume of pneumocephalus for the left and right sides were observed to be 0.24(0.00,0.94)cm3 and 0.48(0.06,1.62)cm3,respectively.There was no significant difference on the left(1.40±0.61 mm vs.1.30±0.55 mm,P=0.299)or the right(1.08±0.52 mm vs.1.19±0.57 mm,P=0.190)deviations of electrodes from the intended target between early and late postoperative periods.The difference in electrode coordinates between late and early postoperative was as follows:left side ΔX=0.41±0.52 mm,ΔY=1.00(0.70,1.50)mm;right side ΔX=0.43±0.50 mm,ΔY=1.00(0.70,1.30)mm.The left intracranial air volume was correlated with leftΔX(r=0.17,P=0.039)and ΔY(r=0.24,P=0.003).The right intracranial air volume was not correlated with right ΔX(r=0.10,P=0.388)but correlated with right ΔY(r=0.44,P＜0.001).Conclusion Our findings indicate that following deep brain stimulation in patients with Parkinson's disease,the electrode position shifts forward and laterally due to the absorption of intracranial air and the restitution of brain tissue.
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