Lesioning Through a Directional Deep Brain Stimulation Lead in the Subthalamic Nucleus

Area of Science:

• Neurosurgery
• Neurology
• Medical Devices

Background:

• Parkinson's disease (PD) is often treated with subthalamic nucleus deep brain stimulation (DBS).
• Hardware-related infections can necessitate DBS system removal, leading to loss of therapeutic benefit.
• Patients may face challenges with device removal and subsequent treatment options.

Purpose of the Study:

• To describe a novel technique for lesioning the subthalamic nucleus using the existing DBS lead.
• To evaluate the feasibility of creating a targeted subthalamotomy during hardware explantation.
• To offer an alternative treatment for PD patients with DBS hardware infections.

Main Methods:

• A 59-year-old woman with a Parkinson's disease DBS system infection underwent hardware explantation.
• Radiofrequency ablation was applied through the implanted DBS lead to create a multilevel lesion in the subthalamic nucleus.
• The DBS lead and hardware were subsequently removed.

Main Results:

• The procedure successfully created a targeted subthalamotomy via the existing DBS lead.
• The DBS hardware was safely removed after lesioning.
• This approach provides a therapeutic option for patients with DBS infections.

Conclusions:

• Lesioning through a DBS lead using radiofrequency ablation is a viable therapeutic option for Parkinson's disease patients with hardware infections.
• This technique may be suitable for patients who do not desire re-implantation or have a history of recurrent infections.
• Complexity increases with segmented leads, requiring careful procedural planning.