Postoperative Externalization of Deep Brain Stimulation Leads Does Not Increase Infection Risk

Mostofi, Abteen; Baig, Fahd; Bourlogiannis, Fotios; Uberti, Micaela; Morgante, Francesca; Pereira, Erlick

doi:10.1111/ner.13331

Cited by 8 publications

(6 citation statements)

References 51 publications

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“…27 Furthermore, in line with recent studies suggesting that externalization of DBS electrodes does not increase the risk of SSI, we found no difference in the incidence of SSI following staged or nonstaged procedures. 13,28 In contrast with the literature, we were unable to associate a surgeon's experience with the incidence of SSIs or AEs altogether.…”

Section: Discussionmentioning

confidence: 87%

“…9,10 However, patient-or surgery-related factors associated with and the management of surgical and hardwarerelated AEs of DBS are not frequently described. [11][12][13][14] In light of increased application of DBS in established and emerging indications and substantial resources required for DBS (ie, extensive programming, lifelong follow-up, and recurrent hardware costs), reporting current surgical and hardware-related AEs is essential for evaluating the risk-benefit ratio of this therapy. Here, we present a comprehensive analysis of the AEs that occurred following DBS-associated surgical procedures over a period of ten years in a single center.…”

Section: Introductionmentioning

confidence: 99%

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Surgical and Hardware-Related Adverse Events of Deep Brain Stimulation: A Ten-Year Single-Center Experience

Vlis

Veerdonk

Ackermans

et al. 2022

Neuromodulation: Technology at the Neural Interface

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Introduction: Although deep brain stimulation (DBS) is effective for treating a number of neurological and psychiatric indications, surgical and hardware-related adverse events (AEs) can occur that affect quality of life. This study aimed to give an overview of the nature and frequency of those AEs in our center and to describe the way they were managed. Furthermore, an attempt was made at identifying possible risk factors for AEs to inform possible future preventive measures.Materials and Methods: Patients undergoing DBS-related procedures between January 2011 and July 2020 were retrospectively analyzed to inventory AEs. The mean follow-up time was 43 ± 31 months. Univariate logistic regression analysis was used to assess the predictive value of selected demographic and clinical variables.Results: From January 2011 to July 2020, 508 DBS-related procedures were performed including 201 implantations of brain electrodes in 200 patients and 307 implantable pulse generator (IPG) replacements in 142 patients. Surgical or hardware-related AEs following initial implantation affected 40 of 200 patients (20%) and resolved without permanent sequelae in all instances. The most frequent AEs were surgical site infections (SSIs) (9.95%, 20/201) and wire tethering (2.49%, 5/201), followed by hardware failure (1.99%, 4/201), skin erosion (1.0%, 2/201), pain (0.5%, 1/201), lead migration (0.52%, 2/386 electrode sites), and hematoma (0.52%, 2/386 electrode sites). The overall rate of AEs for IPG replacement was 5.6% (17/305). No surgical, ie, staged or nonstaged, electrode fixation, or patient-related risk factors were identified for SSI or wire tethering.Conclusions: Major AEs including intracranial surgery-related AEs or AEs requiring surgical removal or revision of hardware are rare. In particular, aggressive treatment is required in SSIs involving multiple sites or when Staphylococcus aureus is identified. For future benchmarking, the development of a uniform reporting system for surgical and hardware-related AEs in DBS surgery would be useful.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Surgical and Hardware-Related Adverse Events of Deep Brain Stimulation: A Ten-Year Single-Center Experience

Vlis

Veerdonk

Ackermans

et al. 2022

Neuromodulation: Technology at the Neural Interface

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“…The clinical de nition of infection due to hardware of DBS system was purulence or erythema identi ed from any DBS incision site (cranial, retro-auricular, or IPG), which was subsequently con rmed with a positive culture [1]. In neurosurgery and other surgical areas, DM has been noted as an independent risk factor for the development of postoperative surgical infection [4,5]. To diagnose an infection, at least one of the following is required: (1) purulent drainage, (2) organisms isolated from an aseptically-obtained culture, (3) at least one of the following signs or symptoms of infection: pain or tenderness, localized swelling, erythema or heat, fever (>38°C), or spontaneous dehiscence, (4) an abscess or other evidence of infection that is detected on gross anatomical or histopathological exam or on an imaging test, (5) diagnosis of an surgical site infection(SSI) by a surgeon, attending physician, or other designee [6,7].…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Song

et al. 2022

Preprint

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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.

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“…We conducted a systematic literature search in PubMed regarding infections in DBS and movement disorders using the key terms ([“parkinson’s disease” OR “dystonia” OR “essential tremor”] AND “infection” AND [“deep brain stimulation” OR “deep brain” OR “DBS”] AND “externalization” OR “externalized” OR “externalizing”) with 5 results in February 2021, and (“infection” AND [“deep brain stimulation” OR “deep brain” OR “DBS”] AND [“externalization” OR “externalized” OR “externalizing”]) yielding additional 2 references [20‒25, 39], of which one was a review [25] and one was a case report [39]. Here, we additionally present our results in relation to the major controlled clinical DBS studies [1, 3‒5, 14, 16‒19, 40‒42] (Table 3).…”

Section: Methodsmentioning

confidence: 99%

Risk of Infection after Deep Brain Stimulation Surgery with Externalization and Local-Field Potential Recordings: Twelve-Year Experience from a Single Institution

Feldmann

Neumann

Faust

et al. 2021

Stereotact Funct Neurosurg

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Introduction: Deep brain stimulation (DBS) has been an established surgical procedure in the field of functional neurosurgery for many years. The experimental electrophysiological method of local field potential (LFP) recordings in postsurgically externalized patients has made substantial contributions to the better understanding of pathophysiologies underlying movement disorders. As interest in LFP recordings for the development of improved stimulation strategies increases, this study’s aim was to provide evidence concerning safety of this research method, in a major DBS center. Methods: We retrospectively analyzed incidence and infection characteristics in adult patients who underwent two-staged DBS surgery with temporary externalization of leads in our center between January 2008 and November 2019. We focused on whether patients had participated in LFP recordings, and evaluated incidence of infections at 3 months and 1 year after the surgery based on medical records. Infection rates were compared to major DBS studies and reports focusing on the risk of infection due to externalization of DBS leads. Results were visualized using descriptive statistics. Results: Between January 2008 and November 2019, DBS surgery was performed in 528 patients (389/139 patients in the LFP/non-LFP group), mainly for movement disorders such as Parkinson’s disease (308), dystonia (93), and essential tremor (86). Of the patients, 72.9% participated in LFP recordings. The incidence of infections in the acute postsurgical phase (3 months) was 2.46% and did not differ significantly between the LFP group (1.8%) and the non-LFP group (4.32%). The overall incidence after 1 year amounted to 3.6% (19 patients) with no difference between LFP/non-LFP groups. Incidence rates reported in the literature show a large variety (2.6–10%), and the incidence reported here is within the lower range of reported incidences. Discussion/Conclusion: This study demonstrates that DBS is a surgical procedure with a low risk of infection in a large patient cohort. Importantly, it shows that LFP recordings do not have a significant effect on the incidence of infections in patients with externalization. With a representative cohort of more than 380 patients participating in LFP-recordings, this underlines LFP as a safe method in research and supports further use of this method, for example, for the development of adaptive stimulation protocols.

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Postoperative Externalization of Deep Brain Stimulation Leads Does Not Increase Infection Risk

Cited by 8 publications

References 51 publications

Surgical and Hardware-Related Adverse Events of Deep Brain Stimulation: A Ten-Year Single-Center Experience

Surgical and Hardware-Related Adverse Events of Deep Brain Stimulation: A Ten-Year Single-Center Experience

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

Risk of Infection after Deep Brain Stimulation Surgery with Externalization and Local-Field Potential Recordings: Twelve-Year Experience from a Single Institution

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