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

## TL;DR

A patient with Parkinson's disease had a brain stimulation device removed due to infection, and a lesion was created through the device to maintain therapeutic benefits.

## Contribution

Demonstrates a novel method of creating a lesion using an existing directional DBS lead for therapeutic purposes.

## Key findings

- A multilevel lesion was successfully generated using a directional DBS lead during hardware removal.
- Lesioning through segmented DBS leads is a viable option for patients avoiding re-implantation.
- The procedure introduces procedural complexity but offers therapeutic benefits.

## Abstract

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

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.

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.

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.