1
|
Paterson A, Kumaria A, Sitaraman M, Sabbubeh T, Ingale H, Basu S. Dissection using pulsed radiofrequency energy device (PlasmaBlade) is safe and efficient in experimental revision neuromodulation implant surgery. Br J Neurosurg 2024; 38:439-446. [PMID: 33621158 DOI: 10.1080/02688697.2021.1885622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/22/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The use of functional neurosurgical implants has increased over the past 10 years. PlasmaBlade is an innovative electrosurgical appliance harnessing pulsed radiofrequency (RF) energy. Our aim was to assess the risk of damage to neuromodulation hardware during PlasmaBlade dissection. MATERIALS AND METHODS A simulated setting with chicken breast threaded with different hardware and PlasmaBlade used in three configurations. . Post dissection, the wires were inspected naked eye and under an operating microscope. The induced current was assessed contemporaneously using an oscilloscope. RESULTS Five surgeons tested the PlasmaBlade at different generator settings. Sixty dissections were undertaken. No structural damage or induced current was identified at CUT 3/4, COAG 5. At CUT 6, COAG 5 and during dissection in a perpendicular orientation with prolonged hardware contact, opacification of insulation material occurred in 15/20 dissections. There was no dissolution of insulation even at this setting. On deviation from Medtronic advice, hardware damaged occurred if one was reckless with the PlasmaBlade. CONCLUSION When using the recommended settings and operational technique, PlasmaBlade dissection did not cause any damage to implant wiring/tubing in this simulated setting. This report seeks to add to clinical data suggesting PlasmaBlade is safe for dissection around deep brain stimulator (DBS), vagal nerve stimulator (VNS), and spinal cord stimulator (SCS) hardware.
Collapse
Affiliation(s)
- Alistair Paterson
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Ashwin Kumaria
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Murugan Sitaraman
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Thabit Sabbubeh
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Harshal Ingale
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Surajit Basu
- Department of Neurosurgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| |
Collapse
|
2
|
Servello D, Galbiati TF, Iess G, Minafra B, Porta M, Pacchetti C. Complications of deep brain stimulation in Parkinson's disease: a single-center experience of 517 consecutive cases. Acta Neurochir (Wien) 2023; 165:3385-3396. [PMID: 37773459 DOI: 10.1007/s00701-023-05799-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The number of deep brain stimulation (DBS) procedures is rapidly rising as well as the novel indications. Reporting adverse events related to surgery and to the hardware used is essential to define the risk-to-benefit ratio and develop novel strategies to improve it. OBJECTIVE To analyze DBS complications (both procedure-related and hardware-related) and further assess potential predictive factors. METHODS Five hundred seventeen cases of DBS for Parkinson's disease were performed between 2006 and 2021 in a single center (mean follow-up: 4.68 ± 2.86 years). Spearman's Rho coefficient was calculated to search for a correlation between the occurrence of intracerebral hemorrhage (ICH) and the number of recording tracks. Multiple logistic regression analyzed the probability of developing seizures and ICH given potential risk factors. Kaplan-Meier curves were performed to analyze the cumulative proportions of hardware-related complications. RESULTS Mortality rate was 0.2%, while permanent morbidity 0.6%. 2.5% of cases suffered from ICH which were not influenced by the number of tracks used for recordings. 3.3% reported seizures that were significantly affected by perielectrode brain edema and age. The rate of perielectrode brain edema was significantly higher for Medtronic's leads compared to Boston Scientific's (Χ2(1)= 5.927, P= 0.015). 12.2% of implants reported Hardware-related complications, the most common of which were wound revisions (7.2%). Internal pulse generator models with smaller profiles displayed more favorable hardware-related complication survival curves compared to larger designs (X2(1)= 8.139, P= 0.004). CONCLUSION Overall DBS has to be considered a safe procedure, but future research is needed to decrease the rate of hardware-related complications which may be related to both the surgical technique and to the specific hardware's design. The increased incidence of perielectrode brain edema associated with certain lead models may likewise deserve future investigation.
Collapse
Affiliation(s)
- Domenico Servello
- Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy
| | | | - Guglielmo Iess
- Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy
| | - Brigida Minafra
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Mauro Porta
- Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
3
|
Narváez-Martínez Y, Roldán Ramos P, Hoyos JA, Culebras D, Compta Y, Cámara A, Muñoz E, Martí MJ, Valldeoriola F, Rumià J. Single-Center Complication Analysis Associated with Surgical Replacement of Implantable Pulse Generators in Deep Brain Stimulation. Stereotact Funct Neurosurg 2019; 97:101-105. [PMID: 31280257 DOI: 10.1159/000500210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Internal pulse generator (IPG) replacement is considered a relatively minor surgery but exposes the deep brain stimulation system to the risk of infectious and mechanical adverse events. We retrospectively reviewed complications associated with IPG replacement surgery in our center and reviewed the most relevant publications on the issue. METHODS A retrospective analysis of all the IPG replacements performed in our center from January 2003 until March 2018 was performed. A logistic regression model was used to analyze the risk factors associated with IPG infections at our center. RESULTS A total of 171 IPG replacements in 93 patients were analyzed. The overall rate of replacement complications was 8.8%, whereas the rate of infection was 5.8%. IPG removal was required in 8 out of 10 infected cases. An increased risk of infection was found in patients with subcutaneous thoracic placement of the IPG (OR 5.3, p = 0.016). The most commonly isolated germ was Staphylococcus coagulase negative (60%). We found a non-significant trend towards increased risk of infection in patients with more than 3 replacements (p = 0.07). CONCLUSIONS Infection is the most frequent complication related to IPG replacement. Staphylococcus coagulase negative is the most commonly isolated bacteria causing the infection. According to our results, the subcutaneous thoracic placement represents a greater risk of infection compared to subcutaneous abdominal placement.
Collapse
Affiliation(s)
- Yislenz Narváez-Martínez
- Unit of Functional Neurology and Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain.,Parkinson's Disease & Movement Disorders Unit, Neurology Department, Hospital Clínic de Barcelona/IDIBAPS/University of Barcelona, Institut de Neurociències, Barcelona, Spain
| | - Pedro Roldán Ramos
- Unit of Functional Neurology and Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain, .,Parkinson's Disease & Movement Disorders Unit, Neurology Department, Hospital Clínic de Barcelona/IDIBAPS/University of Barcelona, Institut de Neurociències, Barcelona, Spain,
| | - John Alexander Hoyos
- Unit of Functional Neurology and Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Diego Culebras
- Unit of Functional Neurology and Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Yaroslau Compta
- Parkinson's Disease & Movement Disorders Unit, Neurology Department, Hospital Clínic de Barcelona/IDIBAPS/University of Barcelona, Institut de Neurociències, Barcelona, Spain
| | - Ana Cámara
- Parkinson's Disease & Movement Disorders Unit, Neurology Department, Hospital Clínic de Barcelona/IDIBAPS/University of Barcelona, Institut de Neurociències, Barcelona, Spain
| | - Esteban Muñoz
- Parkinson's Disease & Movement Disorders Unit, Neurology Department, Hospital Clínic de Barcelona/IDIBAPS/University of Barcelona, Institut de Neurociències, Barcelona, Spain
| | - María-Jose Martí
- Parkinson's Disease & Movement Disorders Unit, Neurology Department, Hospital Clínic de Barcelona/IDIBAPS/University of Barcelona, Institut de Neurociències, Barcelona, Spain
| | - Francesc Valldeoriola
- Parkinson's Disease & Movement Disorders Unit, Neurology Department, Hospital Clínic de Barcelona/IDIBAPS/University of Barcelona, Institut de Neurociències, Barcelona, Spain
| | - Jordi Rumià
- Unit of Functional Neurology and Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain.,Parkinson's Disease & Movement Disorders Unit, Neurology Department, Hospital Clínic de Barcelona/IDIBAPS/University of Barcelona, Institut de Neurociències, Barcelona, Spain
| |
Collapse
|
4
|
Ughratdar I, Kawsar KA, Mitchell R, Selway R, Ashkan K. Use of Pulsed Radiofrequency Energy Device (PEAK Plasmablade) in Neuromodulation Implant Revisions. World Neurosurg 2018; 112:31-36. [DOI: 10.1016/j.wneu.2018.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/01/2018] [Accepted: 01/04/2018] [Indexed: 11/26/2022]
|