Artikel
Externalisation of thalamic DBS electrodes for test stimulation in patients with chronic pain: increased risk of infection?
Suche in Medline nach
Autoren
-
Mahmoud Abdallat
- Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
-
Götz Lütjens
- Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
-
Andreas Wloch
- Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
-
Assel Saryyeva
- Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
-
Mihai Manu
- Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
-
Joachim K. Krauss
- Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover
| Veröffentlicht: | 2. Juni 2015 |
|---|
Gliederung
Text
Objective: To determine the risk of short-term and long-term infection in patients with chronic neuropathic pain after externalisation of thalamic deep brain stimulation (DBS) electrodes for test stimulation to select candidates for chronic stimulation.
Method: The study is a retrospective chart review on prospectively collected data of 40 patients who underwent unilateral bifocal thalamic (centromedian-parafascicular nucleus and ventral posterior lateral nucleus) implantation of DBS electrodes for treatment of severe medical refractory chronic neuropathic pain. All patients underwent a test stimulation phase for 3 to 7 days to select candidates for chronic stimulation. All patients received prophylactic antibiotic therapy (cephalosporin) during the test period.
Results: The mean age of patients at the time of surgery was 53.8 years (24–73 years). Follow-up time was up to 17 years. Thirty three patients underwent implantation of a pacemaker after a positive test stimulation period, and 7 patients electrodes were explanted since no improvement was noted.
In 3 out of the 40 patients hardware infection occurred (7.5%). While infection become manifest in two patients within three months after surgery (early infection), in one patients infection was noted at 12 months (late infection). The stimulation system was explanted in these patients after unsuccessful surgical rescue operations and antibiotic therapy. Intraoperative microbiological smears were taken in and showed growth of the staphylococcus aureus in both. In one patient electrode breakage occurred and the electrode fracture was exchanged.
Conclusions: Long-term follow-up of DBS in patients with chronic neuropathic pain reveals an incidence of infection of the DBS system in 7.5%. Review of literature shows, overall infection rates 1–20% in DBS. Therefore the frequency of infection occurs in patients with chronic pain who had externalised DBS electrodes still appears in the upper range. The risk of infection is might be considered acceptable in order to select candidates for chronic stimulation.
