Subacute Subdural Hematoma in a Patient with Bilateral DBS Electrodes

Area of Science:

• Neurosurgery
• Neurology
• Medical Devices

Background:

• Subdural hematomas (SDH) occurring in patients with deep brain stimulating (DBS) electrodes are infrequent, with limited reported cases.
• Current literature lacks established management guidelines for SDH in the presence of DBS hardware.
• This scenario presents a clinical challenge regarding the simultaneous management of the hematoma and the implanted electrodes.

Purpose of the Study:

• To describe the successful management of a patient with a large subdural hematoma and displaced deep brain stimulating electrodes.
• To evaluate the potential for electrode repositioning and continued therapeutic benefit after hematoma evacuation without hardware revision.
• To contribute to the limited understanding of SDH management in patients with DBS.

Main Methods:

• A case report of a 68-year-old female patient with bilateral DBS electrodes who developed an acute subdural hematoma.
• Urgent surgical evacuation of the subdural hematoma was performed.
• Deep brain stimulating electrodes were intentionally left in place without immediate revision.

Main Results:

• The patient presented with severe hemiparesis secondary to a large subacute subdural hematoma and electrode displacement.
• Following urgent hematoma evacuation, hemiparesis resolved, and the brain reexpanded promptly.
• Deep brain stimulating therapy was successfully resumed within 3 weeks and remained stable at 1.5-year follow-up, with electrodes appearing to return to a functional position.

Conclusions:

• Subdural hematomas in patients with deep brain stimulating electrodes, while rare, can be managed effectively.
• Prompt hematoma evacuation and subsequent brain reexpansion may facilitate electrode repositioning, potentially obviating the need for revision surgery.
• This approach allows for the timely restoration of deep brain stimulating therapies, highlighting a conservative management strategy.