title: Cerebral venous infarction: a potentially avoidable complication of deep brain stimulation surgery.
abstract: OBJECTIVE
  Despite numerous reports on the morbidity and mortality of deep brain stimulation (DBS), cerebral venous infarction has rarely been reported. We present four cases of venous infarct secondary to DBS surgery.
  
  
  METHODS
  The diagnosis of venous infarction was based on 1) delayed onset of new neurologic deficits on postoperative day 1 or 2; 2) significant edema surrounding the superficial aspect of the implanted lead, with or without subcortical hemorrhage on CT scan.
  
  
  RESULTS
  Four cases (0.8% per lead, 1.3% per patient) of symptomatic cerebral venous infarction were identified out of 500 DBS lead implantation procedures between July 2002 and August 2009. All four patients had Parkinson's disease. Their DBS leads were implanted in the subthalamic nucleus (n = 2), and the globus pallidus internus (n = 2). Retrospective review of the targeting confirmed that the planned trajectory passed within 3 mm of a cortical vein in two cases for which contrast-enhanced preoperative magnetic resonance (MR) imaging was available. In the other two cases, contrasted targeting images were not obtained preoperatively.
  
  
  CONCLUSIONS
  Cerebral venous infarction is a potentially avoidable, but serious complication. To minimize its incidence, we propose the use of high-resolution, contrast-enhanced, T1-weighted MR images to delineate cerebral venous anatomy, along with careful stereotactic planning of the lead trajectory to avoid injury to venous structures.
authors.affiliation: Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA.
authors.forename: Takashi
authors.initials: T
authors.lastname: Morishita
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.forename: Adam
authors.initials: A
authors.lastname: Burdick
authors.forename: Charles E
authors.initials: CE
authors.lastname: Jacobson
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Foote
mesh_terms: D000368:Aged; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D011859:Radiography; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed
keywords: adverse event; complication; deep brain stimulation; hemorrhage; venous infarction