Does Temporary Externalization of Electrodes After Deep Brain Stimulation Surgery Result in a Higher Risk of Infection?

Autor: Runge J; Department of Neurosurgery, Hannover Medical School, Hannover, Germany. Electronic address: runge.joachim@mh-hannover.de., Nagel JM; Department of Neurosurgery, Hannover Medical School, Hannover, Germany., Blahak C; Department of Neurology, Ortenau-Klinikum, Lahr, Germany., Kinfe TM; Division of Functional Neurosurgery, Friedrich-Alexander University, Erlangen-Nürnberg, Germany., Heissler HE; Department of Neurosurgery, Hannover Medical School, Hannover, Germany., Schrader C; Department of Neurology, Hannover Medical School, Hannover, Germany., Wolf ME; Department of Neurology, Katharinenhospital Stuttgart, Stuttgart, Germany., Saryyeva A; Department of Neurosurgery, Hannover Medical School, Hannover, Germany., Krauss JK; Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
Jazyk: angličtina
Zdroj: Neuromodulation : journal of the International Neuromodulation Society [Neuromodulation] 2024 Apr; Vol. 27 (3), pp. 565-571. Date of Electronic Publication: 2023 Oct 05.
DOI: 10.1016/j.neurom.2023.08.004
Abstrakt: Objectives: Deep brain stimulation (DBS) is a well-established surgical therapy for movement disorders that comprises implantation of stimulation electrodes and a pacemaker. These procedures can be performed separately, leaving the possibility of externalizing the electrodes for local field potential recording or testing multiple targets for therapeutic efficacy. It is still debated whether the temporary externalization of DBS electrodes leads to an increased risk of infection. We therefore aimed to assess the risk of infection during and after lead externalization in DBS surgery.
Materials and Methods: In this retrospective study, we analyzed a consecutive series of 624 DBS surgeries, including 266 instances with temporary externalization of DBS electrodes for a mean of 6.1 days. Patients were available for follow-up of at least one year, except in 15 instances. In 14 patients with negative test stimulation, electrodes were removed. All kinds of infections related to implantation of the neurostimulation system were accounted for.
Results: Overall, infections occurred in 22 of 624 surgeries (3.5%). Without externalization of electrodes, infections were noted after 7 of 358 surgeries (2.0%), whereas with externalization, 15 of 252 infections were found (6.0%). This difference was significant (p = 0.01), but it did not reach statistical significance when comparing groups within different diagnoses. The rate of infection with externalized electrodes was highest in psychiatric disorders (9.1%), followed by Parkinson's disease (7.3%), pain (5.7%), and dystonia (5.5%). The duration of the externalization of the DBS electrodes was comparable in patients who developed an infection (6.1 ± 3.1 days) with duration in those who did not (6.0 ± 3.5 days).
Conclusions: Although infection rates were relatively low in our study, there was a slightly higher infection rate when DBS electrodes were externalized. On the basis of our results, the indication for electrode externalization should be carefully considered, and patients should be informed about the possibility of a higher infection risk when externalization of DBS electrodes is planned.
Competing Interests: Conflict of Interest Joachim Runge received travel grants from Medtronic. Thomas M. Kinfe is a consultant to Medtronic and Abbott. Assel Saryyeva received travel grants from Medtronic. Joachim K. Krauss is a consultant to Medtronic, Boston Scientific, Aleva, and Inomed. The remaining authors report no conflict of interest.
(Copyright © 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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