Methods of scalp revision for deep brain stimulator hardware: case report.
OBJECTIVE
The use of deep brain stimulation (DBS) to treat a variety of disorders has expanded and will result in an increasingly larger number of patients and implanted electrodes. Hardware failure can result from malfunction, lead migration, fracture, and infection. Scalp erosion with exposure of underlying hardware can lead to potential infectious complications and is, in itself, a strong indication for explantation of the neurostimulation system. The patient's relief of symptoms after DBS will be limited by hardware-related complications and thus, strategies to revise scalp overlying hardware are important in the widespread application of DBS.


METHODS
We describe strategies to address complications related to implanted DBS neurostimulator hardware specifically designed to address breach of the integrity of the scalp over the burr hole site. The aim of these approaches is to treat scalp erosion to allow for the reimplantation of previously explanted, infected hardware, or to treat thinned scalp with threatened erosion and prevent the need to remove exposed hardware that is otherwise functioning.


METHODS
Two different approaches are presented: 1) a temporoparieto-occipital flap based on the superficial temporal artery with or without scalp expansion, and 2) a scalp fasciocutaneous flap with or without cranioplasty.


CONCLUSIONS
Stimulation of various deep brain targets helps patients with a wide range of diseases. In the future, with continued refinement, hardware complications can be minimized. Until then, novel approaches need to be developed to save DBS systems and provide symptomatic relief to patients.
Spiotta
Alejandro M
AM
Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Bain
Mark D
MD
Deogaonkar
Milind
M
Boulis
Nicholas M
NM
Rezai
Ali R
AR
Hammert
Warren
W
Lucas
Armand R
AR
D000368:Aged; D020878:Device Removal / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D012535:Scalp / Q000601:surgery*; D013524:Surgical Flaps