Malignant Glioma Developed on a Patient Under Deep Brain Stimulation: Pitfalls in Management

Glioblastoma (GBM) is the most common aggressive malignant primary brain tumor, rarely concurrent in patients who require deep brain stimulation (DBS) implants. Despite the high incidence of these circumstances alone, the coexistence of both in a patient has been seldom reported. In this paper, we report a case of a patient suffering from a movement disorder treated with DBS who developed a GBM.

A patient with bilateral DBS of the globus pallidus internus for refractory secondary dystonia developed a GBM close to the electrode leads, 2.5 years after implantation. The clinical findings, medical management and pitfalls, and possible relationship between the DBS device and the tumor development are discussed. We withdrew the system to perform brain magnetic resonance imaging safely. This revealed an extended lesion that was biopsied. The removal led to a clinical worsening that resulted in fatality, without the possibility of receiving adjuvant treatment. The available literature shows similar management, which depends mainly on the stimulation system used.

We advise the use of magnetic resonance imaging-safe devices; otherwise, we recommend keeping the system and proceeding with computed tomography imaging for diagnostic and management if necessary. The true relationship between chronic DBS stimulation and GBM is to be clarified.