Surgical Management of Deep Brain Stimulator Scalp Erosion without Hardware Removal

Michael D. Staudt, Navid Pourtaheri, Gregory E. Lakin, Hooman Soltanian, Jonathan P. Miller

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Scalp erosion in patients with deep brain stimulation (DBS) hardware is an uncommon complication that lacks a clearly defined management strategy. Previous studies have described various therapies including conservative treatment with antibiotics and surgical debridement with or without hardware removal. Objectives: The aim of this study was to review the efficacy of a hardware-sparing management strategy for the treatment of scalp erosion. Methods: Five patients with previous DBS implantation presented with scalp erosion and visible hardware exposure at the calvarial burr hole site, and underwent tension-free, vascularized, rotational scalp flap, with preservation of the leads under the pericranium. Two of the procedures were performed after an unsuccessful attempt at primary closure and 3 as a primary procedure. Each patient was followed clinically for at least 14 months postoperatively to evaluate for wound-healing and adverse effects. Results: The median duration from initial DBS hardware implantation to erosion and revision surgery was 12 months (range 1.5-62 months). Three patients were documented to have positive intraoperative cultures in spite of the absence of purulence. At the last follow-up, all patients were noted to have complete wound-healing and no evidence of infection or erosion. Conclusions: DBS scalp erosion can be managed by rotational scalp flap without hardware removal, even in cases where infection is identified.

Original languageEnglish (US)
Pages (from-to)385-391
Number of pages7
JournalStereotactic and Functional Neurosurgery
DOIs
StateAccepted/In press - Dec 13 2017
Externally publishedYes

Keywords

  • Deep brain stimulation
  • Erosion
  • Infection
  • Primary closure
  • Reconstruction
  • Rotational flap
  • Split-thickness graft

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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