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

Clinical Vignette: A 59-year-old woman with a previous subthalamic nucleus deep brain stimulation (DBS) implanted for Parkinson’s disease developed a hardware related infection.

Clinical Dilemma: Wound dehiscence and infection developed and necessitated removal of the DBS system. The patient experienced excellent therapeutic benefit from her DBS and expressed concern about device removal.

Clinical Solution: The patient was offered the option of a lesioning procedure which could be performed during hardware explantation. An operative procedure was conducted where the intracranial DBS lead was connected to a radiofrequency system in a deliberate effort to create a targeted subthalamotomy through the existing DBS lead. A multilevel lesion was generated using the contacts on the directional DBS lead. Following the lesion the DBS lead and hardware were removed.

Gap in Knowledge: Creating a lesion through a DBS lead using radiofrequency ablation is a therapeutic option for patients not interested in later re-implantation or for those with a history of multiple DBS related infections. Lesioning through segmented leads introduces more complexity into the procedure.