Can Deep Brain Stimulation Withdrawal Syndromes Be Avoided by Removing Infected Implanted Pulse Generator and Cables with Contralateral Replacement in the Same Session?

OBJECTIVE: Infections are feared complications following deep brain stimulation in 1.9 to 17.6% of cases. These infections can necessitate the removal of implants, which carries the risk of life-threatening withdrawal syndromes, especially in patients suffering from Parkinson's disease. In this report, we describe our procedure of removing an infected implanted pulse generator (IPG) and cables with contralateral replacement in the same session. METHODS: We retrospectively analysed all patients with transpositions of an IPG and cables between 2017 and 2020 in a single-centre, university hospital setting. Medical records of all patients undergoing this particular surgical procedure were systematically reviewed. The shortest follow-up time was 12 months. RESULTS: Between 2017 and 2020, we had 6 patients with a high risk of withdrawal syndrome in whom an infected IPG with cables was removed and replaced on the opposite side in the same session. There were postoperative complications in 2 patients: in one, the generator had to be re-affixed, and in the second, a skin transplant was required over one electrode because of skin necrosis. No case of invasive infection was seen, and the stimulation therapy was not interrupted. CONCLUSION: One-session removal of an IPG and cables with contralateral replacement seems to be an effective therapy for patients at high risk of withdrawal syndrome.

Complications of Impulse Generator Exchange Surgery for Deep Brain Stimulation: A Single-Center, Retrospective Study.

BACKGROUND: Nonrechargeable deep brain stimulation impulse generators (IGs) with low or empty battery status require surgical IG exchange several years after initial implantation. The aim of this study was to investigate complication rates after IG exchange surgery and identify risk factors. METHODS: We retrospectively analyzed complications following IG exchange surgery from 2008 to 2015 in our department. Medical records of all patients who underwent IG exchange surgery were systematically reviewed. The shortest follow-up time was 19 months. RESULTS: From 2008 to 2015, 438 IGs were exchanged in 319 patients. Overall complication rate was 8.90%. Infection developed in 12 patients (2.74%). Six patients (1.37%) experienced local wound erosions. Hardware malfunctions were present in 11 patients (2.51%), and local hemorrhage was observed in 3 cases (0.68%). Repeated fixation of the IG was required in 2 patients (0.46%). Traction of the connecting cables necessitated surgical revision in 2 patients (0.46%). In 2 cases (0.46%), the IG was placed abdominally or exchanged for a smaller device owing to patient discomfort resulting from the initial positioning. One 80-year-old patient (0.23%) had severely worsening heart failure and died 4 days after IG exchange surgery. CONCLUSIONS: IG exchange surgery, although often considered a minor surgery, was associated with a complication rate of approximately 9% in our center. Patients and physicians should understand the complication rates associated with IG exchange surgery because this information might facilitate selection of a rechargeable IG.

Comparison of the Battery Life of Nonrechargeable Generators for Deep Brain Stimulation.

OBJECTIVE: Nonrechargeable deep brain stimulation (DBS) generators must be replaced when the battery capacity is exhausted. Battery life depends on many factors and differs between generator models. A new nonrechargeable generator model replaced the previous model in 2008. Our clinical impression is that the earlier model had a longer battery life than the new one. We conducted this study to substantiate this. METHODS: We determined the battery life of every DBS generator that had been implanted between 2005 and 2012 in our department for the treatment of Parkinson's disease, and compared the battery lives of the both devices. We calculated the current used by estimating the total electrical energy delivered (TEED) based on the stimulation parameters in use one year after electrode implantation. RESULTS: One hundred ninety-two patients were included in the study; 105 with the old and 86 with the new model generators. The mean battery life in the older model was significantly longer (5.44 ± 0.20 years) than that in the new model (4.44 ± 0.17 years) (p = 0.023). The mean TEED without impedance was 219.9 ± 121.5 mW * Ω in the older model and 145.1 ± 72.7 mW * Ω in the new one, which indicated significantly lower stimulation parameters in the new model (p = 0.00038). CONCLUSION: The battery life of the new model was significantly shorter than that of the previous model. A lower battery capacity is the most likely reason, since current consumption was similar in both groups.

Intraoperative resection control using arterial spin labeling - Proof of concept, reproducibility of data and initial results.

OBJECTIVES: Intraoperative magnetic resonance imaging is a unique tool for visualizing structures during resection and/or for updating any kind of neuronavigation that might be hampered as a result of brain shift during surgery. Advanced MRI techniques such as perfusion-weighted imaging have already proven to be important in the initial diagnosis preoperatively, but can also help to differentiate between tumor and surgically induced changes intraoperatively. Commonly used methods to visualize brain perfusion include contrast agent administration and are therefore somewhat limited. One method that uses blood as an internal contrast medium is arterial spin labeling (ASL), which might represent an attractive alternative. MATERIALS AND METHODS: Ten healthy volunteers were examined using three different scanners and coils within 1 h (3T Achieva MRI using 32-channel head coil, 1.5T Achieva MRI using a 6-channel head coil, 1.5 Intera Scanner using 2 surface coils, Philips, Best, The Netherlands) and quantitative CBF values were calculated and compared between the different setups. Additionally, in eight patients with glioblastoma multiforme, ASL was used pre-, intra-, and postoperatively to define tumor tissue and the extent of resection in comparison to structural imaging. RESULTS: A high correlation (r = 0.91-0.96) was found between MRI scanners and coils used. ASL was as reliable as conventional MR imaging if complete resection was already achieved, but additionally provided valuable information regarding residual tumor tissue in one patient. CONCLUSIONS: Intraoperative arterial spin-labeling is a feasible, reproducible, and reliable tool to map CBF in brain tumors and seems to give beneficial information compared to conventional intraoperative MR imaging in partial resection.