Surgical Management of Deep Brain Stimulator Infection without Electrode Removal: Report of Two Cases

Abstract

Objective Stimulation of the subthalamic nucleus by implanted electrodes (deep brain stimulation [DBS]) is performed to suppress symptoms of Parkinson's disease. However, postoperative wound dehiscence and infection can require removal of the implanted electrode leads. This report describes treatment of intractable unilateral wound infection in two patients without removing the DBS device. Methods First, components of the DBS system were removed except for the electrode lead and thorough debridement of the infected wound was conducted. Second, the edges of the bone defect left by removal of DBS components were smoothed to eliminate dead space. Subsequently, the electrode lead was covered by using a pericranial-frontalis-muscle flap or a bi-pedicled-scalp flap with good blood supply. Closed intrawound continuous negative pressure and irrigation treatment was conducted for 1 week after the surgery, and then the drain was removed. Results We treated two patients with wound infection after implantation of DBS electrodes. Case 1 developed a cutaneous fistula and Case 2 had wound dehiscence. After treatment by the method described above, complete wound healing was achieved in both patients. Conclusion DBS is always associated with a risk of infection or exposure of components and treatment can be very difficult. We successfully managed intractable wound infection while leaving the electrode lead in situ, so that it was subsequently possible to continue DBS for Parkinson's disease.

Rescuing Infected Deep Brain Stimulation Therapies in Severely Affected Patients

“…The duration of antibiotic treatment varied among our patients, ranging from 4 to 21 days, with an average of 8.5 days of intravenous antibiotics. The bacteria causing the infections were mostly, except for Patient 2, bacteria from the normal skin flora, consistent with findings in other publications [2,3,11,12,40,41,46]. Tabaja et al, in their publication, reported treating infections with cefazolin, cefuroxime, or vancomycin, which were used as single-shot antibiotics in the initial surgery as well.…”

Intelligent Deep Brain Stimulation Systems: A General Review

“…The removal of electrodes surgically is required when the patient is feeling too much discomfort or if the neuro-physician decides that no more neuromodulation is required. So, removal of electrodes as associated with complications [24]- [27] One study reported that up to 48.5% cases were of reimplantation due to lack of benefit from therapy or improper targeting. North American dataset highlighted cases of removal and revision up to 34.0% from 15.0% [28].…”