Fatal hemorrhage from AVM after DBS surgery: case report

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Intracranial hemorrhage is a known complication of deep brain stimulation (DBS) surgery.
• Hemorrhage typically results from mechanical injury during electrode insertion.
• Hemorrhage due to underlying congenital vascular malformations is less understood.

Observation:

• A patient developed intracerebral hemorrhage post-DBS surgery, distant from the electrode trajectory.
• Initial preoperative and immediate postoperative imaging showed no abnormalities.
• Hemorrhage was detected 24 hours post-surgery, leading to immediate evacuation.

Findings:

• Intraoperative findings revealed abnormal vessels within the occipital lobe hematoma.
• Histopathological analysis confirmed the presence of an arteriovenous malformation (AVM).

Implications:

• This case highlights the potential for DBS surgery to trigger hemorrhage from undetected AVMs.
• Preoperative MR angiography and CT angiography may aid in detecting vascular abnormalities.
• Vigilance for cerebrospinal fluid leakage during surgery is also advised to minimize risks.