Infection following deep brain stimulator implantation performed in the conventional versus magnetic resonance imaging–equipped operating room

Clinical article

Alessandra Gorgulho Department of Neurosurgery, and

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 M.D.
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Catherine Juillard Department of Neurosurgery, and

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Daniel Z. Uslan Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, California

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Katayoun Tajik Department of Neurosurgery, and

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Poorang Aurasteh Department of Neurosurgery, and

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Eric Behnke Department of Neurosurgery, and

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David Pegues Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, California

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Antonio A. F. De Salles Department of Neurosurgery, and

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 M.D., Ph.D.
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Object

Risk factors for deep brain stimulator (DBS) infection are poorly defined. Because DBS implants are not frequently performed in the MR imaging–equipped operating room (OR), no specific data about infection of DBS implants performed in the MR imaging environment are available in the literature. In this study the authors focus on the incidence of infection in patients undergoing surgery in the conventional versus MR imaging–equipped OR.

Methods

To identify cases of DBS-associated infection, the authors performed a retrospective cohort study with nested case-control analysis of all patients undergoing DBS implantation at the University of California Los Angeles Medical Center. Cases of DBS infection were identified using standardized clinical and microbiological criteria.

Results

Between January 1998 and September 2003, 228 DBSs were implanted. Forty-seven operations (20.6%) were performed in the conventional OR and 181 (79.4%) in the MR imaging–equipped OR. There was definite infection in 13 cases (5.7%) and possible infection in 7 cases (3%), for an overall infection rate of 8.7% (20 of 228 cases). There was no significant difference in infection rates in the conventional (7 [14.89%] of 47) versus MR imaging–equipped OR (13 [7.18%] of 181) (p = 0.7). Staphylococcus aureus was isolated in 62% of cases. Twelve of 13 confirmed cases underwent complete hardware removal. On case-control analysis, younger age (≤ 58.5 years) was a significant predictor of DBS infection (odds ratio 3.4, p = 0.027)

Conclusions

Infection is a serious complication of DBS implantation and commonly requires device removal for cure. The authors found that DBS implantation can be safely performed in MR imaging–equipped suites, possibly allowing improved lead placement. Young age was associated with an increased risk of DBS infection.

Abbreviations used in this paper:

CI = confidence interval; DBS = deep brain stimulator; GPI = globus pallidus internus; OR = operating room; PD = Parkinson disease; SD = standard deviation; STN = subthalamic nucleus; UCLA = University of California Los Angeles; VIM = ventralis intermedius.
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