Rescuing Infected Deep Brain Stimulation Therapies in Severely Affected Patients

Abstract

(1) Background: Infections in deep brain stimulation (DBS) hardware, while an undesired complication of DBS surgeries, can be effectively addressed. Minor infections are typically treated with wound revision and IV antibiotics. However, when visible hardware infection occurs, most centers opt for complete removal, leaving the patient in a preoperative state and necessitating post-removal care. To avoid the need for such care, a novel technique was developed. (2) Methods: The electrodes are placed at the exact same spot and then led to the contralateral side. new extensions and a new generator contralateral to the infection as well. Subsequently, the infected system is removed. This case series includes six patients. (3) Results: The average duration of DBS system implantation before the second surgery was 272 days. Only one system had to be removed after 18 months due to reoccurring infection; the others remained unaffected. Laboratory alterations and pathogens were identified in only half of the patients. (4) Conclusions: The described surgical technique proves to be safe, well tolerated, and serves as a viable alternative to complete system removal. Importantly, it effectively prevents the need of post-removal care for patients.

Keywords: deep brain stimulation; infection; salvage surgery.

Figure 1

Step-by-step documentation of placing the new electrodes. (A) The patient’s head is fixed inside the ring, and two planar X-rays are taken with localizers. (B) After fusing an empty CT scan with ring and localizer with the X-rays, the tips and entry points of the electrodes in both X-rays are tagged. (C) These coordinates are used to generate the trajectories. (D) After removing the old electrode, a new one is inserted into the old pathway. It is documented that the electrode follows the old trajectory. (E) After reaching the target point, the electrode is fixed.

Figure 2

Patient 1, one day before salvage surgery. The red line indicates the current position of the generator, while the yellow line represents its former position, threatening to perforate the skin.

Figure 3

The image shows the condition 89 months after the single-stage replacement surgery for Patient 3. The right electrode was removed, rendering the DBS therapy insufficient. Replacing the electrode was not an option due to the patient’s heart condition.

Figure 4

Patient 4 presented with a swollen generator pocket several weeks after an infected bee sting directly above the generator.

Figure 5

PubMed research within a PRISMA flow diagram leading up to our cited articles.