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Post-mortem histopathology of a pediatric brain after bilateral DBS of GPI for status dystonicus: case report and review of the literature

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Abstract

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.

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Authors and Affiliations

  1. Department of Neurosurgery, Children’s Hospital A. Meyer-University of Florence, Florence, Italy

    Flavio Giordano, Simone Peraio, Lorenzo Genitori, Matteo Lenge & Regina Mura

  2. Functional and Epilepsy Neurosurgery Unit, Department of Neurosurgery, Children’s Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139, Florence, Italy

    Flavio Giordano

  3. Division of Pathology, Children’s Hospital A. Meyer-University of Florence, Florence, Italy

    Chiara Caporalini & Anna Maria Buccoliero

  4. Department of Neurosurgery, Sant’Anna Hospital University of Ferrara, Ferrara, Italy

    Lorenzo Mongardi & Michele Alessandro Cavallo

  5. Child Neurology Unit and Laboratories, Children’s Hospital A. Meyer-University of Florence, Florence, Italy

    Matteo Lenge & Federico Melani

  6. Pediatric Anesthesiology and Intensive Care Unit, Children’s Hospital A. Meyer-University of Florence, Florence, Italy

    Manuela L’Erario & Michele Pennica

  7. Diagnostic Imaging Unit, Children’s Hospital A. Meyer-University of Florence, Florence, Italy

    Leonardo Lelli

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  1. Flavio Giordano
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Correspondence to Flavio Giordano.

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Giordano, F., Caporalini, C., Peraio, S. et al. Post-mortem histopathology of a pediatric brain after bilateral DBS of GPI for status dystonicus: case report and review of the literature. Childs Nerv Syst 36, 1845–1851 (2020). https://doi.org/10.1007/s00381-020-04761-w

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