Surgical Management of Deep Brain Stimulator Scalp Erosion without Hardware Removal.
| Autor: | Staudt MD; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA., Pourtaheri N, Lakin GE, Soltanian HT, Miller JP |
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| Jazyk: | angličtina |
| Zdroj: | Stereotactic and functional neurosurgery [Stereotact Funct Neurosurg] 2017; Vol. 95 (6), pp. 385-391. Date of Electronic Publication: 2017 Dec 13. |
| DOI: | 10.1159/000484323 |
| Abstrakt: | Background: Scalp erosion in patients with deep brain stimulation (DBS) hardware is an uncommon complication that lacks a clearly defined management strategy. Previous studies have described various therapies including conservative treatment with antibiotics and surgical debridement with or without hardware removal. Objectives: The aim of this study was to review the efficacy of a hardware-sparing management strategy for the treatment of scalp erosion. Methods: Five patients with previous DBS implantation presented with scalp erosion and visible hardware exposure at the calvarial burr hole site, and underwent tension-free, vascularized, rotational scalp flap, with preservation of the leads under the pericranium. Two of the procedures were performed after an unsuccessful attempt at primary closure and 3 as a primary procedure. Each patient was followed clinically for at least 14 months postoperatively to evaluate for wound-healing and adverse effects. Results: The median duration from initial DBS hardware implantation to erosion and revision surgery was 12 months (range 1.5-62 months). Three patients were documented to have positive intraoperative cultures in spite of the absence of purulence. At the last follow-up, all patients were noted to have complete wound-healing and no evidence of infection or erosion. Conclusions: DBS scalp erosion can be managed by rotational scalp flap without hardware removal, even in cases where infection is identified. (© 2017 S. Karger AG, Basel.) |
| Databáze: | MEDLINE |
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