Radiofrequency ablation through previously effective deep brain stimulation leads for Parkinson's disease: A retrospective series.

BACKGROUND While deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) is the current surgical method of choice to treat the canonical symptoms of Parkinson's disease, occasionally surgical sites become infected or the hardware erodes, necessitating explantation. Usual practice is to remove and re-implant replacement leads after tissue healing, leaving patients without the clinical benefits of DBS for several months, and at risk for DBS withdrawal in some, and some patients are no longer good surgical candidates for reimplantation. Radiofrequency ablation through the DBS lead is an option for these patients. METHODS We performed a retrospective chart review of all patients that underwent radiofrequency ablation of the STN or GPi through indwelling DBS leads performed prior to hardware removal at our institution. We generated patient specific anatomical models to determine lesion locations and volumes. RESULTS Six patients underwent radiofrequency ablation of the STN (n=4) and GPi (n=2) through indwelling DBS leads. All six of these patients initially exhibited comparable motor symptom relief to that experienced with DBS prior to lesioning, with four patients sustaining meaningful long-term (≥2 years) improvement. Better outcomes were achieved in those patients with a higher percentage of the planned target lesioned. CONCLUSIONS Radiofrequency ablation through indwelling DBS leads prior to explantation could be considered a viable alternative to subsequent reimplantation or stereotactic lesion in patients with Parkinson's disease where hardware explantation is necessary, provided the patient achieved substantive symptom relief with DBS. This approach avoids symptom exacerbation while awaiting revision surgery.