Surgical Management of Deep Brain Stimulator Scalp Erosion without Hardware Removal

Abstract

Background: Scalp erosion in patients with deep brain stimulation (DBS) hardware is an uncommon complication that lacks a clearly defined management strategy. Previous studies have described various therapies including conservative treatment with antibiotics and surgical debridement with or without hardware removal. Objectives: The aim of this study was to review the efficacy of a hardware-sparing management strategy for the treatment of scalp erosion. Methods: Five patients with previous DBS implantation presented with scalp erosion and visible hardware exposure at the calvarial burr hole site, and underwent tension-free, vascularized, rotational scalp flap, with preservation of the leads under the pericranium. Two of the procedures were performed after an unsuccessful attempt at primary closure and 3 as a primary procedure. Each patient was followed clinically for at least 14 months postoperatively to evaluate for wound-healing and adverse effects. Results: The median duration from initial DBS hardware implantation to erosion and revision surgery was 12 months (range 1.5-62 months). Three patients were documented to have positive intraoperative cultures in spite of the absence of purulence. At the last follow-up, all patients were noted to have complete wound-healing and no evidence of infection or erosion. Conclusions: DBS scalp erosion can be managed by rotational scalp flap without hardware removal, even in cases where infection is identified.

Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays

“…After screening titles and abstracts, 479 potentially relevant articles were identified, and the full text was assessed against the inclusion criteria. Finally, 240 articles were chosen to be included in this meta‐analysis …”

Skin erosion in deep brain stimulation procedures: Using the temporalis muscle to treat this complication – A technical note

“…All patients had healthy flaps, the DBS hardware was functional, and there was no evidence of infection or local pain. [ 26 ]…”

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

“…Then we covered the electrode lead by using a local flap such as a pericranial flap or bi-pedicled scalp flap with good blood supply. 8 Flaps such as galeal, temporalis fascial, or pericranial flaps are reliable, thin, and supple, as well as having a good arc of rotation and minimal donor site morbidity. 9 These flaps can also be raised in the vicinity of the operative field, which is convenient for the neurosurgeon.…”