title: Deep brain stimulator implantation in a diagnostic MRI suite: infection history over a 10-year period.
abstract: OBJECTIVE The objective of this study was to assess the incidence of postoperative hardware infection following interventional (i)MRI-guided implantation of deep brain stimulation (DBS) electrodes in a diagnostic MRI scanner. METHODS A diagnostic 1.5-T MRI scanner was used over a 10-year period to implant DBS electrodes for movement disorders. The MRI suite did not meet operating room standards with respect to airflow and air filtration but was prepared and used with conventional sterile procedures by an experienced surgical team. Deep brain stimulation leads were implanted while the patient was in the magnet, and patients returned 1-3 weeks later to undergo placement of the implantable pulse generator (IPG) and extender wire in a conventional operating room. Surgical site infections requiring the removal of part or all of the DBS system within 6 months of implantation were scored as postoperative hardware infections in a prospective database. RESULTS During the 10-year study period, the authors performed 164 iMRI-guided surgical procedures in which 272 electrodes were implanted. Patients ranged in age from 7 to 78 years, and an overall infection rate of 3.6% was found. Bacterial cultures indicated Staphylococcus epidermis (3 cases), methicillin-susceptible Staphylococcus aureus (2 cases), or Propionibacterium sp. (1 case). A change in sterile practice occurred after the first 10 patients, leading to a reduction in the infection rate to 2.6% (4 cases in 154 procedures) over the remainder of the procedures. Of the 4 infections in this patient subset, all occurred at the IPG site. CONCLUSIONS Interventional MRI-guided DBS implantation can be performed in a diagnostic MRI suite with an infection risk comparable to that reported for traditional surgical placement techniques provided that sterile procedures, similar to those used in a regular operating room, are practiced.
authors.affiliation: Departments of 1 Radiology and Biomedical Imaging.
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Martin
authors.affiliation: Neurological Surgery, and.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Larson
authors.affiliation: Neurology, University of California, San Francisco, California.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ziman
authors.affiliation: Neurological Surgery, and.
authors.forename: Nadja
authors.initials: N
authors.lastname: Levesque
authors.affiliation: Neurology, University of California, San Francisco, California.
authors.forename: Monica
authors.initials: M
authors.lastname: Volz
authors.affiliation: Neurology, University of California, San Francisco, California.
authors.forename: Jill L
authors.initials: JL
authors.lastname: Ostrem
authors.affiliation: Neurological Surgery, and.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Starr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D046690:Deep Brain Stimulation / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053783:Magnetic Resonance Imaging, Interventional; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D013997:Time Factors; D055815:Young Adult
keywords: DBS; DBS = deep brain stimulation; IPG = implantable pulse generator; MRI; MSSA = methicillin-susceptible Staphylococcus aureus; deep brain stimulation; functional neurosurgery; iMRI = interventional MRI; infection