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Fortmann T, Zawy Alsofy S, Lewitz M, Santacroce A, Welzel Saravia H, Sakellaropoulou I, Wilbers E, Grabowski S, Stroop R, Cinibulak Z, Nakamura M, Lehrke R. Rescuing Infected Deep Brain Stimulation Therapies in Severely Affected Patients. Brain Sci 2023; 13:1650. [PMID: 38137098 PMCID: PMC10742038 DOI: 10.3390/brainsci13121650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/02/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Infections in deep brain stimulation (DBS) hardware, while an undesired complication of DBS surgeries, can be effectively addressed. Minor infections are typically treated with wound revision and IV antibiotics. However, when visible hardware infection occurs, most centers opt for complete removal, leaving the patient in a preoperative state and necessitating post-removal care. To avoid the need for such care, a novel technique was developed. (2) Methods: The electrodes are placed at the exact same spot and then led to the contralateral side. new extensions and a new generator contralateral to the infection as well. Subsequently, the infected system is removed. This case series includes six patients. (3) Results: The average duration of DBS system implantation before the second surgery was 272 days. Only one system had to be removed after 18 months due to reoccurring infection; the others remained unaffected. Laboratory alterations and pathogens were identified in only half of the patients. (4) Conclusions: The described surgical technique proves to be safe, well tolerated, and serves as a viable alternative to complete system removal. Importantly, it effectively prevents the need of post-removal care for patients.
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Affiliation(s)
- Thomas Fortmann
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (S.Z.A.); (M.L.); (A.S.); (E.W.); (R.S.); (Z.C.); (M.N.)
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany; (H.W.S.); (I.S.); (S.G.)
- Department of Stereotactic Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany;
| | - Samer Zawy Alsofy
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (S.Z.A.); (M.L.); (A.S.); (E.W.); (R.S.); (Z.C.); (M.N.)
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany; (H.W.S.); (I.S.); (S.G.)
| | - Marc Lewitz
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (S.Z.A.); (M.L.); (A.S.); (E.W.); (R.S.); (Z.C.); (M.N.)
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany; (H.W.S.); (I.S.); (S.G.)
| | - Antonio Santacroce
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (S.Z.A.); (M.L.); (A.S.); (E.W.); (R.S.); (Z.C.); (M.N.)
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany; (H.W.S.); (I.S.); (S.G.)
- European Radiosurgery Center Munich, 81377 Munich, Germany
| | - Heinz Welzel Saravia
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany; (H.W.S.); (I.S.); (S.G.)
| | - Ioanna Sakellaropoulou
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany; (H.W.S.); (I.S.); (S.G.)
| | - Eike Wilbers
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (S.Z.A.); (M.L.); (A.S.); (E.W.); (R.S.); (Z.C.); (M.N.)
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany; (H.W.S.); (I.S.); (S.G.)
| | - Steffen Grabowski
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany; (H.W.S.); (I.S.); (S.G.)
| | - Ralf Stroop
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (S.Z.A.); (M.L.); (A.S.); (E.W.); (R.S.); (Z.C.); (M.N.)
| | - Zafer Cinibulak
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (S.Z.A.); (M.L.); (A.S.); (E.W.); (R.S.); (Z.C.); (M.N.)
- Department of Neurosurgery, Academic Hospital Koeln-Merheim, Witten/Herdecke University, 51109 Koeln, Germany
| | - Makoto Nakamura
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany; (S.Z.A.); (M.L.); (A.S.); (E.W.); (R.S.); (Z.C.); (M.N.)
- Department of Neurosurgery, Academic Hospital Koeln-Merheim, Witten/Herdecke University, 51109 Koeln, Germany
| | - Ralph Lehrke
- Department of Stereotactic Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfaelische Wilhelms-University Muenster, 59073 Hamm, Germany;
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Ribeiro L, Chan-Seng E, Gil V, Sanrey E, Coubes P, Poulen G. Submammary Implantation of Internal Pulse Generators for Deep Brain Stimulation: Long-Term Follow-up of Device Acceptance and Quality of Life in Women. World Neurosurg 2022; 167:e1025-e1031. [PMID: 36058486 DOI: 10.1016/j.wneu.2022.08.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A submammary approach to implanting pulse generators is innovative and has yielded good aesthetic results in the current literature. It was our aim to make a comparison of patient device acceptance, tolerance, and complications between submammary and abdominal device locations in deep brain stimulation. METHODS Twenty-five and 28 patients were included in the submammary and abdominal groups, respectively. Our primary criterion was patient acceptance that was calculated using total Florida Patient Acceptance Survey (FPAS) scores in each group. Secondarily, tolerance was assessed in the submammary group by means of a specific questionnaire. RESULTS Total FPAS scores from the submammary group [total FPAS: 77.1 versus 74.7, P = 0.29] revealed no significant difference when compared with the abdominal group. The same similarities were observed regarding the 4 subscales: return to function [16.3 versus 15.8, P = 0.53], device-related distress [22.0 versus 21.3, P = 0.31], body image concerns [9.2 versus 8.6, P = 0.14], and positive appraisal [17.8 versus 17.4, P = 0.58]. Tolerance was reported as good by the majority of the women from the submammary group. There was no evidence of higher infection rates in the submammary implantation (SMI) group. CONCLUSIONS SMI is a satisfactory alternative to other deep brain stimulation locations. SMI is a feasible option for any young woman who is eligible for deep brain stimulation.
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Affiliation(s)
- Lucas Ribeiro
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France; Unité de Recherche sur les Comportements et mouvements anormaux, Institut de Génomique Fonctionnelle, CHU Montpellier, Montpellier, France
| | - Emilie Chan-Seng
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France; Unité de Recherche sur les Comportements et mouvements anormaux, Institut de Génomique Fonctionnelle, CHU Montpellier, Montpellier, France
| | - Valérie Gil
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France; Unité de Recherche sur les Comportements et mouvements anormaux, Institut de Génomique Fonctionnelle, CHU Montpellier, Montpellier, France
| | - Emily Sanrey
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France; Unité de Recherche sur les Comportements et mouvements anormaux, Institut de Génomique Fonctionnelle, CHU Montpellier, Montpellier, France
| | - Philippe Coubes
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France; Unité de Recherche sur les Comportements et mouvements anormaux, Institut de Génomique Fonctionnelle, CHU Montpellier, Montpellier, France
| | - Gaëtan Poulen
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France; Unité de Recherche sur les Comportements et mouvements anormaux, Institut de Génomique Fonctionnelle, CHU Montpellier, Montpellier, France.
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Petrou IG, Momjian S, Modarressi A. Submammary placement of neurostimulator devices: broadening the spectrum of cosmetic techniques. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01665-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractDeep brain neurostimulators (DBS) have enabled thousands of individuals to overcome movement disorders, thus offering them a new chance for social integration while enhancing their self-esteem. A classic DBS consists of a central implantable pulse generator (IPG) and its respective wires and leads that extend to the scalp to reach the brain. The classic positioning of the generator is currently subcutaneous, usually just below the clavicle or in the abdominal wall. As DBS systems are of a substantial size, this subcutaneous placement leads to unsightly and visible devices, particularly in thin patients. We report two cases of female patients who benefited from our technique to hide the IPG under the breast parenchyma. IPGs were placed through an inframammary incision in a subglandular pocket, similar to the technique used for implant-based breast augmentation. In the first case, the devices were implanted in a subglandular pocket and replaced 5 years later due to battery life limitation. In the second case, the devices were replaced from a subclavicular position to a submammary one. No major or minor complications were observed. Both patients reported an excellent level of satisfaction with the aesthetic and functional outcome. Despite the significant quality of life improvement of patients with DBS, the ideal implantation of the generator should also take into consideration the comfort and cosmetic aspects. Our approach has the potential to markedly improve the aesthetic outcome of such an intervention.Level of evidence: Level V, therapeutic study.
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Bullard AJ, Hutchison BC, Lee J, Chestek CA, Patil PG. Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays. Neuromodulation 2019; 23:411-426. [DOI: 10.1111/ner.13069] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/05/2019] [Accepted: 09/10/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Autumn J. Bullard
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | | | - Jiseon Lee
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | - Cynthia A. Chestek
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Electrical Engineering and Computer Science University of Michigan Ann Arbor MI USA
| | - Parag G. Patil
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Neurosurgery University of Michigan Medical School Ann Arbor MI USA
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