Fatal Hemorrhage From AVM After DBS Surgery: Case Report

Authors

  • Chikashi Fukaya MD, PhD,

    Corresponding author
    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
    • Address correspondence to: Chikashi Fukaya, MD, PhD, Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo 173-8610, Japan. Email: chikashi@med.nihon-u.ac.jp

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  • Kentaro Shimoda MD, PhD,

    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
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  • Mitsuru Watanabe MD, PhD,

    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
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  • Takashi Morishita MD, PhD,

    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
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  • Koichiro Sumi MD, PhD,

    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
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  • Toshiharu Otaka MD, PhD,

    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
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  • Toshiki Obuchi MD, PhD,

    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
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  • Kano Toshikazu MD, PhD,

    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
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  • Kazutaka Kobayashi MD, PhD,

    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
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  • Hideki Oshima MD, PhD,

    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
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  • Takamitsu Yamamoto MD, PhD,

    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
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  • Yoichi Katayama MD, PhD

    1. Nihon University Hospital, Neuromodulation Center, Department of Neurological Surgery, Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan
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  • Conflict of Interest: The authors reported no conflicts of interest.
  • Authorship: Drs. Yamamoto T and Katayama Y conducted the study, including the advisement and final check of the manuscript. Drs. Oshima H, Kobayashi K and Kano T prepared the manuscript draft and figures. Drs. Obuchi, Otaka, Sumi and Shimoda took the important role for treatment of this patient and record the patient clinical history and support to collect the patient's data, including MR images, pathological sample and so on. In addition, we would like to thank Drs. Morishita and Watanabe their editorial support of this manuscript. All authors approved the submitted manuscript.

Abstract

Objectives

Intracranial hemorrhage is a crucial complication of deep brain stimulation (DBS) surgery. The bleeding caused by mechanical tissue injury due to microelectrode and/or DBS electrode lead insertion has been well studied. However, hemorrhage caused by a congenital underlying disease such as vascular malformation has not been examined carefully.

Materials and Methods

We encountered a case of intracerebral hemorrhage from arteriovenous malformation (AVM) after DBS surgery. Preoperative magnetic resonance (MR) imaging did not show any abnormality in the patient. Computed tomography (CT) images taken immediately after the surgery did not show any intracranial hematoma and other abnormal findings. However, the patient did not recover from the general anesthesia, and hemorrhage in the left occipital lobe was detected by CT performed a day after the surgery. The location of the hematoma was markedly distant from the trajectory of DBS leads. Evacuation of the hematoma under general anesthesia was immediately performed.

Results

As an intraoperative finding, we noted the presence of abnormal vessels inside the hematoma in the occipital lobe. Tissue specimens including the abnormal vessels were obtained for histopathological analysis, results of which led to the diagnosis was AVM.

Conclusion

Despite its low incidence, we would like to advise that such a type of hemorrhage could occur and measures should be taken to prevent its occurrence as much as possible. Preoperative detection of abnormal vessels by MR angiography and/or CT angiography might be helpful. Moreover, paying close attention to the possible leakage of cerebrospinal fluid during surgery might be important.

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