Wound complications are uncommon following deep brain stimulation (DBS) surgery. However, certain key technical steps can be performed in each procedure to minimize this still troublesome risk. The authors reviewed the incidence and management of all hardware-related wound dehiscences and infections in a large patient series.
All patients undergoing new DBS hardware implantation surgery between 2002 and 2010 by a single surgeon (R.K.S.) were entered into a database after undergoing verification by cross-referencing manufacturer implantation records. All hardware-related complications such as wound dehiscence, erosions, and/or infections were identified, and wound location, time of incidence, and mechanism were categorized. Charts were reviewed to evaluate the success of conservative treatment versus partial or total hardware removal.
Seven hundred twenty-eight patients received 1333 new DBS leads and 1218 new implantable pulse generators (IPGs) in a total of 1356 stereotactic procedures for movement disorders. Seventy-eight percent of patients underwent staged lead and IPG implantations. Sixteen patients presented with atraumatic device-related infection and/or dehiscence within 12 months from original implantation; 9 of these patients (1.24%) required additional surgery after antibiotic failure. All 8 patients presenting with cranial wound complications were treated initially by debridement in an attempt to salvage the leads; debridement followed by intravenous antibiotics was only successful in 2 patients presenting with dehiscence alone. One of 2 lead-only removals was successful in infections originating in the cranium; the only IPG-originating infection was treated by partial hardware removal and intravenous antibiotics. Two of 637 IPG replacements resulted in infections within 12 months after revision, requiring either partial or total hardware removal, while 1 dehiscence in this group was treated by debridement alone.
In a large series of new DBS hardware implantations, the incidence of postoperative wound dehiscence and/or infections requiring further surgery was 1.24%. Standard practice for all implantations was a short procedural duration, copious povidone-iodine irrigation, and postoperative antibiotic administration. Partial hardware removal should be initially attempted for infection. Debridement alone is successful in treating dehiscence without infection.
Abbreviations used in this paper:ET = essential tremor; DBS = deep brain stimulation; IPG = implantable pulse generator; MRSA = methicillin-resistant Staphylococcus aureus; MSSA = methicillinsensitive S. aureus; PD = Parkinson disease.
Address correspondence to: Albert J. Fenoy, M.D., Mischer Neuroscience Institute, Department of Neurosurgery, University of Texas-Houston Health Science Center, 6400 Fannin, Suite 2800, Houston, Texas 77030. email: email@example.com.
Please include this information when citing this paper: published online March 9, 2012; DOI: 10.3171/2012.1.JNS111798.
BenabidALKoudsieABenazzouzAPiallatBvan BlerkomNFraixV: Subthalamic nucleus deep brain stimulation. LozanoAM: Movement Disorder Surgery. Progress in Neurological Surgery Vol 15Basel, Karger2000. 196–226
BenabidAL, KoudsieA, BenazzouzA, PiallatB, van BlerkomN, FraixV, : Subthalamic nucleus deep brain stimulation. LozanoAM: Basel, Karger, 2000. 196–226)| false
BoviatsisEJStavrinouLCThemistocleousMKouyialisATSakasDE: Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature. Acta Neurochir (Wien)152:2053–20622010
BoviatsisEJ, StavrinouLC, ThemistocleousM, KouyialisAT, SakasDE: Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature. 152:2053–2062, 2010)| false
GoodmanRRKimBMcClellandSIIISenatusPBWinfieldLMPullmanSL: Operative techniques and morbidity with subthalamic nucleus deep brain stimulation in 100 consecutive patients with advanced Parkinson's disease. J Neurol Neurosurg Psychiatry77:12–172006
GoodmanRR, KimB, McClellandSIII, SenatusPB, WinfieldLM, PullmanSL, : Operative techniques and morbidity with subthalamic nucleus deep brain stimulation in 100 consecutive patients with advanced Parkinson's disease. 77:12–17, 2006)| false
SciubbaDMStuartRMMcGirtMJWoodworthGFSamdaniACarsonB: Effect of antibiotic-impregnated shunt catheters in decreasing the incidence of shunt infection in the treatment of hydrocephalus. J Neurosurg103:2 Suppl131–1362005
SciubbaDM, StuartRM, McGirtMJ, WoodworthGF, SamdaniA, CarsonB, : Effect of antibiotic-impregnated shunt catheters in decreasing the incidence of shunt infection in the treatment of hydrocephalus. 103:2 Suppl131–136, 2005)| false
SimonTDHallMRiva-CambrinJAlbertJEJeffriesHELafleurB: Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. Clinical article. J Neurosurg Pediatr4:156–1652009
SimonTD, HallM, Riva-CambrinJ, AlbertJE, JeffriesHE, LafleurB, : Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. Clinical article. 4:156–165, 2009)| false
StarrPASillayKComplication avoidance and management in deep brain stimulation surgery. TarsyDVitekJLStarrPA: Deep Brain Stimulation in Neurological and Psychiatric Disorders. Current Clinical NeurologyTotowa, NJHumana Press2008. 135–150
StarrPA, SillayK, Complication avoidance and management in deep brain stimulation surgery. TarsyD, VitekJL, StarrPA, : Totowa, NJ, Humana Press, 2008. 135–150)| false
VogesJWaerzeggersYMaaroufMLehrkeRKoulousakisALenartzD: Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery—experiences from a single centre. J Neurol Neurosurg Psychiatry77:868–8722006
VogesJ, WaerzeggersY, MaaroufM, LehrkeR, KoulousakisA, LenartzD, : Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery—experiences from a single centre. 77:868–872, 2006)| false