Frameless x-ray-based lead re-implantation after partial hardware removal of deep brain stimulation system with preservation of intracerebral trajectories

Abstract

Background Deep brain stimulation (DBS) is an established treatment for patients with medical refractory movement disorders with continuously increasing use also in other neurological and psychiatric diseases. Early and late complications can lead to revision surgeries with partial or complete DBS-system removal. In this study, we aimed to report on our experience with a frameless x-ray-based lead re-implantation technique after partial hardware removal or dysfunction of DBS-system, allowing the preservation of intracerebral trajectories. Methods We describe a surgical procedure with complete implant removal due to infection except for the intracranial part of the electrode and with non-stereotactic electrode re-implantation. A retrospective analysis of a patient series treated using this technique was performed and the surgical outcome was evaluated including radiological and clinical parameters. Results A total of 8 DBS-patients with lead re-implantation using the frameless x-ray-based method were enrolled in the study. A revision of 14 leads was performed, whereof a successful lead re-implantation could be achieved without any problems in 10 leads (71%). In two patients (one patient with dystonia and one patient with tremor), the procedure was not successful, so we placed both leads frame-based stereotactically. Conclusions The described x-ray-based technique allows a reliable frameless electrode re-implantation after infection and electrode dysfunction and might represent an efficient alternative to frame-based procedures for lead revision making the preservation of intracerebral trajectories possible.

Recurrent Infections Leading to DBS Removal but Reimplantation Achieving a Good Outcome: a Case Report

“…Typical ndings include brous sheaths of 5-25 mm surrounding the electrode track, a chronic in ammation with reactive astrocytes, multinucleated giant cells, macrophages, mononuclear leucocytes and T-lymphocytes, brillary gliosis and Rosenthal bers [20]. Glial scarring around DBS leads in the brain has been described previously and this is thought to be the result of an in ammatory response of microglia to the leads [3].…”

“…As the number of DBS procedure increases, so does the number of lead removal procedure performed due to infection, erosion, lead breakage and suboptimal placement [2]. There are currently no standardised recommendations for the management of complications following DBS surgery and for the reimplantation of hardware after its removal due to complications [3]. Here we described a surgical procedure with complete implants removal due to infections but reimplantation of a new DBS system achieved a good outcome in a patient with PD for over 20 years.…”