Is It Possible to Save the Deep Brain Stimulation Hardware when Presenting with Wound Dehiscence or Hardware...

Area of Science:

• Neurosurgery
• Biomedical Engineering
• Neurology

Background:

• Deep brain stimulation (DBS) hardware complications traditionally necessitate complete system removal.
• System explantation leads to treatment interruption and reimplantation challenges.
• Novel approaches are needed to manage DBS hardware complications while minimizing patient impact.

Purpose of the Study:

• To evaluate the efficacy of avoiding complete explantation for DBS hardware complications.
• To assess outcomes of hardware-sparing revisions for wound dehiscence and infection.

Main Methods:

• Retrospective study of 30 patients with DBS hardware complications (wound dehiscence/infection).
• Management strategies included hardware-sparing revision, partial explantation, or complete explantation.
• Analysis of complication location, management success rates, and need for subsequent lead removal.

Main Results:

• 17/30 cases underwent hardware-sparing wound revisions, with a 76.5% success rate, primarily for scalp dehiscence.
• 11/30 cases had partial explantation (mostly generator-related), achieving a 64% success rate.
• 33% of lead-sparing approaches ultimately required intracranial lead removal; only 2/30 infections needed total explantation.

Conclusions:

• Wound dehiscence associated with DBS hardware can often be managed successfully without complete system removal.
• Component removal while sparing intracranial leads may be a viable option for hardware infections.
• Hardware-sparing wound revision is safe, preserves DBS treatment, and enhances patient quality of life.