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Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery

Published on: January 6, 2011

Aim for the Suprasternal Notch: Technical Note to Avoid Bowstringing after Deep Brain Stimulation.

Harith Akram¹, Patricia Limousin, Jonathan Hyam

¹Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London, UK.

Stereotactic and Functional Neurosurgery

|May 23, 2015

Summary

This summary is machine-generated.

Directing deep brain stimulation (DBS) extension cables towards the suprasternal notch may prevent bowstringing, a rare complication caused by fibrosis. This surgical modification reduces patient discomfort and improves cosmetic outcomes.

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Area of Science:

Neurosurgery
Medical Devices
Surgical Complications

Background:

Excessive fibrosis around deep brain stimulation (DBS) extension cables can cause bowstringing, particularly when cables cross the clavicle.
This complication, though rare, leads to significant patient discomfort and cosmetic concerns.

Purpose of the Study:

To investigate the hypothesis that directing DBS extension cables towards the suprasternal notch can prevent bowstringing.
To evaluate the efficacy of a modified surgical technique in reducing fibrosis-related complications.

Main Methods:

A retrospective review of patients undergoing DBS surgery over 10 years.
Analysis of cable tunneling techniques, specifically comparing superficial clavicular routes with routes directed towards the suprasternal notch.
In cases of pre-existing fibrosis, surgical revision involved opening and excising the fibrous tunnel to allow medial cable rerouting.

Main Results:

Of 429 patients, 7 (2%) experienced bowstringing with cables tunneled over the clavicle; surgical rerouting resolved this and improved cosmesis.
No instances of bowstringing were observed in patients whose cables were initially directed towards the suprasternal notch.
The modified technique demonstrated a reduction in the incidence of this adverse event.

Conclusions:

The trajectory of DBS extension cable tunneling significantly influences the development of postoperative fibrosis.
Modifying the surgical technique to route cables towards the suprasternal notch appears to be an effective strategy for reducing the incidence of bowstringing.