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Revision of deep brain stimulator for tremor. Technical note
J M Schwalb1, H A Riina, B Skolnick
1Department of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia 19104, USA.
Journal of Neurosurgery
|June 21, 2001
Summary
Deep brain stimulation (DBS) lead breakage near the cervical connector can necessitate revision surgery. Relocating the connector to the parietal region may prevent future electrode fractures and improve system durability.
Area of Science:
- Neurosurgery
- Neurology
- Biomedical Engineering
Background:
- Thalamic deep brain stimulation (DBS) is a common treatment for essential tremor, offering advantages over thalamotomy.
- DBS system implantation involves electrodes, connectors, and generators, which can lead to specific complications.
- Lead breakage is a potential morbidity associated with implanted DBS systems.
Purpose of the Study:
- To report on three cases of deep brain stimulation (DBS) lead breakage occurring at the cervical connector site.
- To describe the surgical revision and management of these DBS system failures.
- To propose modifications to the surgical procedure to enhance the durability of DBS systems and reduce complications.
Main Methods:
- Case series review of three patients with essential tremor treated with DBS who experienced lead fractures.
- Surgical revision involving stereotactic retargeting and placement of new intracranial electrodes.
- Modification of connector placement from the cervical region to the subgaleal parietal region during revision surgery.
Main Results:
- Three patients presented with fractured DBS electrodes near the cervical connector site.
- Revision surgery required reoperation with stereotactic retargeting and new electrode implantation.
- Connectors were repositioned to the subgaleal parietal region during revision.
Conclusions:
- Placing DBS electrode connectors in the cervical region increases the risk of lead fracture due to patient movement.
- Revision surgery for DBS lead fracture carries a higher risk of morbidity compared to initial implantation.
- Prophylactic relocation of connectors to the subgaleal parietal region is recommended to prevent future DBS electrode fractures and associated complications.