Reducing hardware-related complications of deep brain stimulation.
BACKGROUND
Deep brain stimulation (DBS) is used increasingly worldwide for the treatment of Parkinson's disease, dystonia, tremor and pain. As with any implanted system, however, DBS introduces a new series of problems related to its hardware. Infection, malfunction and lead migration or fracture may increase patient morbidity and should be considered when evaluating the risk/benefit ratio of this therapy. This work highlights several factors felt to increase DBS hardware complications.


METHODS
The authors undertook a prospective analysis of their patients receiving this therapy in two Canadian centres, over a four-year period.


RESULTS
One hundred and forty-four patients received 204 permanent electrode implants. The average follow-up duration was 24 months. Complications related to the DBS hardware were seen in 11 patients (7.6%). There were two lead fractures (1.4%) and nine infections (6.2%) including two erosions (1.4%). There was a significantly greater risk of infection in patients who underwent staged procedures with externalization. In patients with straight scalp incisions, the rate of infection was higher than that seen with curved incisions.


CONCLUSIONS
Hardware complications were not common. A period of externalization of the electrodes for a stimulation trial was associated with an increased infection rate. It is also possible that a straight scalp incision instead of curvilinear incision may lead to an increase in the rate of infection. With a clear understanding of the accepted DBS device indications and their potential complications, patients may make a truly informed decision about DBS technology.
Constantoyannis
Constantine
C
Division of Neurosurgery at the University of British Columbia, Halifax, Canada.
Berk
Caglar
C
Honey
Christopher R
CR
Mendez
Ivar
I
Brownstone
Robert M
RM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000503:physiopathology / Q000601:surgery*; D001927:Brain Diseases / Q000503:physiopathology / Q000628:therapy*; D002170:Canada; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000295:instrumentation* / Q000592:standards; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D011446:Prospective Studies; D012086:Reoperation / Q000009:adverse effects / Q000706:statistics & numerical data; D012307:Risk Factors; D012535:Scalp / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome