Purpose

To investigate the effects of deep brain stimulation (DBS) electrodes on the brain of a dystonic pediatric patient submitted to bilateral DBS of the globus pallidus internus (GPI).

Methods

An 8-year-old male patient underwent bilateral DBS of GPI for status dystonicus. He died 2 months later due to multiorgan failure triggered by bacterial pneumonia. A post-mortem pathological study of the brain was done.

Results

At visual inspection, no grossly apparent softening, hemorrhage, or necrosis of the brain adjacent to the DBS lead tracts was detected. High-power microscopic examination of the tissue surrounding the electrode trajectories showed lymphocyte infiltration, astrocytic gliosis, microglia, macrophages, and clusters of multinucleate giant cells. Significant astrocytosis was confirmed by GFAP staining in the electrode site. The T cell lymphocyte activity was overexpressed with activated macrophages detected with CD3, CD20, CD45, and CD68 stains respectively. There was no gliosis or leukocyte infiltration away from the surgical tracks of the electrodes.

Conclusion

This is the first post-mortem examination of a child’s brain after bilateral DBS of GPI. The comparison with adult post-mortem reports showed no significant differences and confirms the safety of DBS implantation in the pediatric population too.

中文翻译：

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GPI双侧DBS治疗肌张力障碍后小儿脑的尸检组织病理学：病例报告和文献回顾。

目的

研究深部脑刺激 (DBS) 电极对接受双侧苍白球 (GPI) DBS 治疗的肌张力障碍儿科患者大脑的影响。

方法

一名 8 岁男性患者因肌张力障碍接受 GPI 双侧 DBS。2个月后，他因细菌性肺炎引发的多器官衰竭去世。对大脑进行了尸检病理学研究。

结果

在目视检查中，未检测到与 DBS 导联束相邻的大脑明显软化、出血或坏死。电极轨迹周围组织的高倍显微镜检查显示淋巴细胞浸润、星形胶质细胞增生、小胶质细胞、巨噬细胞和多核巨细胞簇。通过电极部位的 GFAP 染色证实了显着的星形细胞增多症。T 细胞淋巴细胞活性过表达，活化的巨噬细胞分别用 CD3、CD20、CD45 和 CD68 染色检测。远离电极的手术轨迹没有神经胶质增生或白细胞浸润。

结论

这是 GPI 双侧 DBS 后儿童大脑的首次尸检。与成人尸检报告的比较显示没有显着差异，也证实了 DBS 植入在儿科人群中的安全性。