Deep Brain Stimulation Peri Lead Cyst Resolution with Nonoperative Management: Case Report and Review of the Literature.

Deep brain stimulation (DBS) is an effective treatment for medically refractory essential tremor (ET) and Parkinson's disease. We present the case of a patient treated with thalamic DBS for ET who developed a large right peri-lead cyst with associated edema three months postoperatively, causing symptoms of dysarthria and left-sided weakness. The patient was treated nonoperatively with a course of steroids and serial observation. Over three months, the cyst regressed in size, with resolution of the associated symptoms. The patient was ultimately able to continue bilateral DBS for ET, which provided relief from upper-extremity tremor. By 9 months after the cyst was diagnosed (one year postoperatively from DBS) he was fully recovered back to baseline. We review other cases of peri-lead cysts and edema, of which etiology and presentation remain varied and unclear. Peri-lead cysts are a rare complication of DBS with an estimated incidence of 0.8%. Ultimately, this case shows that appropriately selected peri-lead cysts may be managed nonoperatively, allowing for continued DBS benefit in patients by avoiding lead removal.