Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Apr;164(4):1183-1186.
doi: 10.1007/s00701-022-05135-8. Epub 2022 Feb 25.

Surgical management of "Twiddler syndrome" in patients with deep brain stimulation: a technical note and review of the literature

Z Krause Molle  1 , P Slotty  1 , J Vesper  2
Affiliations
Review

Surgical management of "Twiddler syndrome" in patients with deep brain stimulation: a technical note and review of the literature

Z Krause Molle et al. Acta Neurochir (Wien). 2022 Apr.

Abstract

Background: The Twiddler syndrome (TS) describes a situation in which the implanted impulse generator (IPG) rotates several times around its own axis in the subcutaneous pocket. This can lead to severe mechanical damage of the leads and extensions and to dislocations.

Method: Hereby, we report on a technique for revision surgery in patients diagnosed with Twiddler syndrome after undergoing previous deep brain stimulation (DBS) surgery. For revision surgery, the TYRX ™ Absorbable Antibacterial Envelope was used.

Conclusion: The TS can be treated well with the envelope TYRX ™ Absorbable Antibacterial Envelope TYRX ™.

Keywords: Deep brain stimulation; Implanted impulse generator; Twiddler syndrome.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
The thoracic X-ray (a.p.) shows the dislocation of the pectoral neurostimulator with twisted extensions (arrow)
Fig. 2
Fig. 2
Intraoperative imaging of the twisted extensions in the IPG pocket
Fig. 3
Fig. 3
Intraoperative imaging with caudal fixation (A) and implantation of the TYRX ™ Absorbable Antibacterial Envelope with the device in the subcutaneous pocket (B). This is followed by the fixation of the neurostimulator with the Dacron bag on the cranial pole after the electrodes have been connected (C)
Fig. 4
Fig. 4
Postoperative chest x-ray with no signs of twisting of the electrodes
See this image and copyright information in PMC

References

    1. Al-Mahfoudh R, Chan Y, Chong HP, Farah JO. Twiddler’s syndrome in spinal cord stimulation. Acta Neurochir (Wien) 2016;158:147–154. doi: 10.1007/s00701-015-2627-x. - DOI - PMC - PubMed
    1. Champagne C, u. a., “Twiddler syndrome without lead dislodgment discovered by remote monitoring”, Case Rep Cardiol, Bd. 2021, Feb. 2021, 10.1155/2021/8816524. - PMC - PubMed
    1. Ghanchi H, Taka TM, Bernstein JE, Kashyap S, Ananda AK. “The unsuccessful Twiddler: a case of Twiddler’s syndrome without deep brain stimulator lead breakage”. Cureus. 2020;12(4):e7786. doi: 10.7759/cureus.7786. - DOI - PMC - PubMed
    1. Haslam M, Parkman HP, Petrov RV. “Absorbable antibacterial envelope in the surgical management of Twiddler’s syndrome in a patient with gastric electric stimulator: a case report”. Dig Med Res. 2020;3:76. doi: 10.21037/dmr-20-70. - DOI - PMC - PubMed
    1. Kawata H, u. a., “Obese female patients have higher rates of lead dislodgement after ICD or CRT-D implantation”, Int J Cardiol, Bd. 172, Nr. 3, S. e522–524, Apr. 2014, 10.1016/j.ijcard.2014.01.076. - PubMed

Publication types

Substances