An alternative scalp incision for deep brain stimulation surgery: A long term follow-up study

This study aimed to evaluate an alternative scalp incision technique designed to enhance flap vascularity and to position implanted hardware away from the incision line, thereby reducing the risk of scalp erosion, a frequent complication of deep brain stimulation (DBS) surgery.

We retrospectively reviewed a database of 106 patients who underwent DBS surgery using a novel scalp incision technique over a 10-year period. To evaluate the efficacy of this technique, outcomes were compared with a previous series of 102 patients operated on using traditional C-shaped incisions. The incidence, timing, and clinical characteristics of incision-related infections and scalp skin erosion were systematically analyzed.

Between 2015 and 2025, DBS surgery using the alternative incision technique was performed in 106 patients (45 female and 61 male). The mean follow-up duration was 54 ± 29.2 months. Compared to the previous series, which had a 5.9% (6/102) infection rate and a 2.9% (3/102) erosion rate, the crescent-shaped incision demonstrated a significant reduction in infections (p = 0.013) and a clinical decrease in erosion rates (p = 0.116). Throughout the 10-year observation period, no patients experienced scalp skin erosion or incision-related infection associated with the implanted hardware.

Our findings suggest that the use of a wider scalp flap, in contrast to traditional straight or curved incisions, combined with avoidance of a retroauricular incision, significantly reduces hardware-related scalp complications following DBS surgery.