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

Abstract

Background: Deep brain stimulation (DBS) is an established treatment for patients with medical refractory Parkinson's disease (PD). DBS systems are implanted with the aim of providing permanent treatment, but infections, several early and late hardware related complications, suboptimal outcomes ,which might require revision operations with partial or even complete hardware removal. 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. Case presentation: A 70-year-old male with idiopathic PD for 22 years who underwent bilateral subthalamic nucleus (STN) DBS surgery with a non-rechargeable implantable pulse generator (IPG) when he was diagnosed PD for 8 years. His past history included hypertension and type 2 diabetes mellitus (DM). He underwent IPG replacement surgery in his 4th and 9th year after his initial DBS implantation. Four years after his latest IPG replacement surgery, he developed recurrent skin erosion around the DBS system. He underwent a total of four local incisions debridements (including two times of dissociated flap transplantation) and several sessions of antibiotic therapy before the final removal of the hardware. Fortunately after completion of antibiotic treatment, he underwent implantation of a new DBS system nine months later. No further complications appeared at the ninth months follow-up after reimplantation. The patient's symptoms had improved to a great extent, and he could take care of himself and his quality of life had improved significantly, which met the needs of the patient and his family.Conclusions: Infection is one of the most serious and difficult complications to manage after DBS implantation. Treatment of this complication can take a long time and lead to additional hospitalization, surgery and partial or total removal of the DBS system. However as long as the indications are met in any case, the reimplantation procedure can be reconsidered later, despite having had an infection and the electrode being removed.