Lead Reimplantation Utilizing the Pre-existing Lead Tract: A Case Report of Deep Brain Stimulation Lead Fracture Management.
Lead Reimplantation Utilizing the Pre-existing Lead Tract: A Case Report of Deep Brain Stimulation Lead Fracture Management.
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
Sapporo, JP · Author affiliation
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.Location evidence
Otaru, JP · Author affiliation
Department of Neurosurgery, Otaru General Hospital, Otaru, Hokkaido, Japan.Location evidence
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Original abstract
Deep brain stimulation lead fracture may necessitate intracranial lead replacement. If deep brain stimulation was clinically effective before the fracture, reimplantation along the original trajectory to the same target is preferable; however, detailed technical descriptions remain limited. We present a 70-year-old woman with Parkinson disease who underwent subthalamic nucleus-deep brain stimulation. Two months after surgery, partial impedance abnormalities were detected on the left lead. At 12 months, all contacts demonstrated abnormal impedance, accompanied by worsening motor symptoms. Fourteen months after the initial surgery, we attempted to place a new lead by manually advancing it through the scar tissue that had formed along the original lead tract. Stereotactic reimplantation using a Leksell frame was prepared as a contingency if this scar-guided approach proved unsuccessful. After reopening the prior incision, the original lead was removed without resistance, and the cortical entry point was clearly identified. The preinserted stylet was removed from a new deep brain stimulation lead, which was then gently advanced through the original entry point along the pre-existing tract without reinsertion of the stylet. The lead progressed smoothly, and C-arm fluoroscopy confirmed that the tip corresponded to the prior position. Intraoperative test stimulation improved symptoms without adverse effects. Postoperative computed tomography confirmed that the reimplanted lead was positioned in an almost identical location to the prior lead. Stimulation was resumed with clinical benefit, and lead function remained normal at 6 months. Scar-guided reinsertion may represent a practical alternative; however, stereotactic backup should remain readily available, as adequate tract formation cannot be reliably predicted preoperatively.