Reuse of Internal Pulse Generator in Cases of Infection after Deep Brain Stimulation Surgery

2014 ◽  
Vol 92 (3) ◽  
pp. 140-144 ◽  
Author(s):  
Selcuk Gocmen ◽  
Ozkan Celiker ◽  
Abdullah Topcu ◽  
Aikaterini Panteli ◽  
Goksemin Acar ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Internal Pulse Generator ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

scholarly journals Placement of the Internal Pulse Generator for Deep Brain Stimulation in the Upper Back to Prevent Fracture of the Extension Wire due to Generator Rotation: Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Ankur Garg ◽  
Avinash L. Mohan ◽  
P. Charles Garell
Keyword(s):  
Case Report ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Surgical Procedure ◽  
Pulse Generator ◽  
Potential Complication ◽  
Hardware Failure ◽  
Internal Pulse Generator ◽  
Deep Brain

Deep brain stimulation (DBS) is a common surgical procedure used for the treatment of Parkinson's disease (PD) and essential tremor. A potential complication of this procedure is hardware failure. The authors report a case of DBS hardware failure in which repeated fractures of the extension wire were caused by abnormal rotational movements of the IPG placed in the loose subclavicular tissue of an overweight female. Implantation of the IPG in the suprascapular area prevented further extension wire fractures. This strategy may be especially relevant in overweight females with loose subclavicular tissue.

3-Tesla MRI in patients with fully implanted deep brain stimulation devices: a preliminary study in 10 patients

2017 ◽  
Vol 127 (4) ◽  
pp. 892-898 ◽  
Author(s):  
Francesco Sammartino ◽  
Vibhor Krishna ◽  
Tejas Sankar ◽  
Jason Fisico ◽  
Suneil K. Kalia ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Safety Data ◽  
Phantom Study ◽  
Maximum Temperature ◽  
Clinical Safety ◽  
Internal Pulse Generator ◽  
Neurological Effects ◽  
Deep Brain

OBJECTIVEThe aim of this study was to evaluate the safety of 3-T MRI in patients with implanted deep brain stimulation (DBS) systems.METHODSThis study was performed in 2 phases. In an initial phantom study, a Lucite phantom filled with tissue-mimicking gel was assembled. The system was equipped with a single DBS electrode connected to an internal pulse generator. The tip of the electrode was coupled to a fiber optic thermometer with a temperature resolution of 0.1°C. Both anatomical (T1- and T2-weighted) and functional MRI sequences were tested. A temperature change within 2°C from baseline was considered safe. After findings from the phantom study suggested safety, 10 patients with implanted DBS systems targeting various brain areas provided informed consent and underwent 3-T MRI using the same imaging sequences. Detailed neurological evaluations and internal pulse generator interrogations were performed before and after imaging.RESULTSDuring phantom testing, the maximum temperature increase was registered using the T2-weighted sequence. The maximal temperature changes at the tip of the DBS electrode were < 1°C for all sequences tested. In all patients, adequate images were obtained with structural imaging, although a significant artifact from lead connectors interfered with functional imaging quality. No heating, warmth, or adverse neurological effects were observed.CONCLUSIONSTo the authors' knowledge, this was the first study to assess the clinical safety of 3-T MRI in patients with a fully implanted DBS system (electrodes, extensions, and pulse generator). It provided preliminary data that will allow further examination and assessment of the safety of 3-T imaging studies in patients with implanted DBS systems. The authors cannot advocate widespread use of this type of imaging in patients with DBS implants until more safety data are obtained.

scholarly journals Surgical management of adverse events associated with deep brain stimulation: A single-center experience

2020 ◽  
Vol 8 ◽  
pp. 205031212091345
Author(s):  
Masani Nonaka ◽  
Takashi Morishita ◽  
Kazumichi Yamada ◽  
Shinsuke Fujioka ◽  
Masa-aki Higuchi ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Adverse Events ◽  
Surgical Management ◽  
Brain Stimulation ◽  
Surgical Complications ◽  
Pulse Generator ◽  
Implantable Pulse Generator ◽  
Surgical Methods ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Objectives: Deep brain stimulation is widely used to treat movement disorders and selected neuropsychiatric disorders. Despite the fact, the surgical methods vary among centers. In this study, we aimed to evaluate our own surgical complications and how we performed surgical troubleshooting. Methods: A retrospective chart review was performed to evaluate the clinical data of patients who underwent deep brain stimulation surgery and deep brain stimulation–related procedures at our center between October 2014 and September 2019. We reviewed surgical complications and how surgical troubleshooting was performed, regardless of where the patient underwent the initial surgery. Results: A total of 92 deep brain stimulation lead implantation and 43 implantable pulse generator replacement procedures were performed. Among the 92 lead implantation procedures, there were two intracranial lead replacement surgeries and one deep brain stimulation lead implantation into the globus pallidus to add to existing deep brain stimulation leads in the bilateral subthalamic nuclei. Wound revision for superficial infection of the implantable pulse generator site was performed in four patients. There was neither intracerebral hemorrhage nor severe hardware infection in our series of procedures. An adaptor (extension cable) replacement was performed due to lead fracture resulting from a head trauma in two cases. Conclusion: We report our experience of surgical management of adverse events associated with deep brain stimulation therapy with clinical vignettes. Deep brain stimulation surgery is a safe and effective procedure when performed by a trained neurosurgeon. It is important for clinicians to be aware that there are troubles that are potentially manageable with optimal surgical treatment.

scholarly journals Streamlining deep brain stimulation surgery by reversing the staging order

2015 ◽  
Vol 122 (5) ◽  
pp. 1042-1047 ◽  
Author(s):  
Craig G. van Horne ◽  
Scott W. Vaughan ◽  
Carla Massari ◽  
Michael Bennett ◽  
Wissam S. Z. Asfahani ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
General Anesthesia ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Stage I ◽  
Stage Ii ◽  
Patient Anxiety ◽  
Stereotactic Frame ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Deep brain stimulation (DBS) is approved for several clinical indications; however, the sequencing of DBS surgery and the timeline for implementing stimulation therapy are not standardized. In over 140 cases so far, the authors have reversed the sequencing for staged implantation of DBS systems that was conducive to minimizing patient anxiety and discomfort while providing the opportunity to shorten the time between implantation and programming for therapeutic management of symptoms. Stage I was performed with the patient under general anesthesia and consisted of implantation of the pulse generator and lead extensions and placement of the bur holes. Stage II was completed 1–7 days later, using only local anesthesia, and included stereotactic frame-based microelectrode recordings, semi-microstimulation and macrostimulation, and testing and placement of the stimulating electrodes. Stage I lasted approximately 90 minutes, whereas Stage II lasted approximately 230 minutes. All patients tolerated the procedures and received a complete implanted system. Deep brain stimulation therapy was typically initiated on the same day as lead implantation. When sequencing was reversed and bur holes were placed during the first stage while a patient was under general anesthesia, the patient was able to tolerate the second awake stage and was able to begin stimulation therapy within 48 hours of the second stage.

Reoperation for device infection and erosion following deep brain stimulation implantable pulse generator placement

2020 ◽  
Vol 133 (2) ◽  
pp. 403-410 ◽  
Author(s):  
Travis J. Atchley ◽  
Nicholas M. B. Laskay ◽  
Brandon A. Sherrod ◽  
A. K. M. Fazlur Rahman ◽  
Harrison C. Walker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Pulse Generator ◽  
Rank Test ◽  
Implantable Pulse Generator ◽  
Device Infection ◽  
Deep Brain

OBJECTIVEInfection and erosion following implantable pulse generator (IPG) placement are associated with morbidity and cost for patients with deep brain stimulation (DBS) systems. Here, the authors provide a detailed characterization of infection and erosion events in a large cohort that underwent DBS surgery for movement disorders.METHODSThe authors retrospectively reviewed consecutive IPG placements and replacements in patients who had undergone DBS surgery for movement disorders at the University of Alabama at Birmingham between 2013 and 2016. IPG procedures occurring before 2013 in these patients were also captured. Descriptive statistics, survival analyses, and logistic regression were performed using generalized linear mixed effects models to examine risk factors for the primary outcomes of interest: infection within 1 year or erosion within 2 years of IPG placement.RESULTSIn the study period, 384 patients underwent a total of 995 IPG procedures (46.4% were initial placements) and had a median follow-up of 2.9 years. Reoperation for infection occurred after 27 procedures (2.7%) in 21 patients (5.5%). No difference in the infection rate was observed for initial placement versus replacement (p = 0.838). Reoperation for erosion occurred after 16 procedures (1.6%) in 15 patients (3.9%). Median time to reoperation for infection and erosion was 51 days (IQR 24–129 days) and 149 days (IQR 112–285 days), respectively. Four patients with infection (19.0%) developed a second infection requiring a same-side reoperation, two of whom developed a third infection. Intraoperative vancomycin powder was used in 158 cases (15.9%) and did not decrease the infection risk (infected: 3.2% with vancomycin vs 2.6% without, p = 0.922, log-rank test). On logistic regression, a previous infection increased the risk for infection (OR 35.0, 95% CI 7.9–156.2, p < 0.0001) and a lower patient BMI was a risk factor for erosion (BMI ≤ 24 kg/m2: OR 3.1, 95% CI 1.1–8.6, p = 0.03).CONCLUSIONSIPG-related infection and erosion following DBS surgery are uncommon but clinically significant events. Their respective timelines and risk factors suggest different etiologies and thus different potential corrective procedures.

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