Transaxillary subpectoral implantation of implantable pulse generator for deep brain stimulation.
OBJECTIVE
Deep brain stimulation (DBS) is an effective modality of treating cardinal motor symptoms of several movement disorders such as Parkinson's disease, essential tremor, and dystonia. Although hardware-related complications of DBS have been reported, the cosmetic satisfaction and discomfort associated with infraclavicular subcutaneous implantation of the pulse generator has not been described. The authors adopted a technique of transaxillary subpectoral implantable pulse generator (IPG) placement and investigated the difference in the discomfort, cosmetic satisfaction, mean operation time for IPG implantation, and severity of postoperative pain between infraclavicular subcutaneous placement and transaxillary subpectoral implantation of IPG.


METHODS
25 patients who underwent bilateral, infraclavicular subcutaneous IPG placement for DBS and 15 patients who had bilateral, transaxillary subpectoral IPG placement were investigated.


RESULTS
The differences in cosmetic satisfaction and discomfort between the two groups were significant. The cosmetic satisfaction was higher and discomfort was less in the subpectoral IPG implantation group (p = 0.002 and p = 0.000). However, more time was needed for IPG implantation, and the postoperative pain was more severe after subpectoral IPG implantation (p = 0.002 and p = 0.000). There was no difference in cosmetic satisfaction according to sex (p = 0.907). There was one transient intercostobrachial nerve injury in the subpectoral IPG implantation group and two infections which needed removal of one side of the DBS hardware in the infraclavicular IPG implantation group.


CONCLUSIONS
These results demonstrated that subpectoral transaxillary IPG implantation can provide better cosmetic satisfaction in patients undergoing DBS, with less discomfort and morbidity related to erosion and infection.
Department of Neurosurgery, St Vincent's Hospital, The Catholic University of Korea, Suwon, Korea. sbc@catholic.ac.kr
Byung-chul
BC
Son
Soo-hyung
SH
Han
Yoon-suk
YS
Choi
Hyung-suk
HS
Kim
Min-cheol
MC
Kim
Seung-ho
SH
Yang
Sang-won
SW
Lee
D000368:Aged; D001365:Axilla / Q000601:surgery*; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D009069:Movement Disorders / Q000628:therapy; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010369:Pectoralis Muscles / Q000601:surgery*; D012189:Retrospective Studies; D040521:Subcutaneous Tissue / Q000601:surgery