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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Complications in impulse generator exchange surgery for Deep Brain Stimulation

Meeting Abstract

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  • Ann-Kristin Helmers - UKSH Kiel, Klinik für Neurochirurgie , Kiel, Deutschland
  • Isabell Lübbing - UKSH Kiel, Klinik für Neurochirurgie , Kiel, Deutschland
  • Karsten Witt - UKSH Kiel, Klinik für Neurologie, Kiel, Deutschland
  • Michael Synowitz - UKSH Kiel, Klinik für Neurochirurgie , Kiel, Deutschland
  • Hubertus Maximilian Mehdorn - UKSH Kiel, Klinik für Neurochirurgie , Kiel, Deutschland
  • Daniela Falk - UKSH Kiel, Klinik für Neurochirurgie , Kiel, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 153

doi: 10.3205/17dgnc716, urn:nbn:de:0183-17dgnc7169

Published: June 9, 2017

© 2017 Helmers et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Low or empty battery status of non-rechargeable deep brain stimulation impulse generators (IG) requires a surgical IG exchange several years after initial implantation. Complications in patients undergoing DBS surgery are reported in the range between 7,6 % up to 25,3 %. The aim of this study was to investigate the rate of complications after IG exchanges and to identify risk factors for complications.

Methods: We retrospectively analyzed the complications in IG exchange surgery from 2008 to 2015 in a single center university hospital setting. Medical reports from all patients, who had undergone IG exchange surgery were systematically reviewed. The shortest follow-up was 11 months.

Results: From 2008 to 2015, 438 generators were exchanged in 319 patients. Overall complication rate and revision rate was 8,9 % of cases. 13 patients (2,96 %) developed an infection of the IG with a secondary removal of the IG. Five patients (1,14 %) suffered from local wound erosions surrounding the IG; for this particular complication in one patient the IG had to be removed while in the other 4 patients a local wound revision was sufficient. We found hardware malfunctions in 11 patients (2,51 %) and local hemorrhage surrounding the IG in three cases (0,68 %)requiring surgical revision. In two patients (0,46 %) the IG needed to be refixated. In two patients (0,46 %) tension of the connecting cables triggered a surgical revision because of patient’s discomfort. One 80 years patient (0,23%) suffered from worsened severe heart failure and died 4 days after IG exchange in local anesthesia. In two cases (0,46 %) the IG was placed abdominally or exchanged to a smaller device due to patient discomfort from initial positioning.

Conclusion: IG exchange surgery, although often considered “minor surgery”, is associated with a complication rate of roughly 9% in our center. Infection is the most relevant complication as it causes removal of the IG. The implantation of smaller IGs might reduce complications such as wound erosions or local hemorrhages. Patients and physicians should know the rate of complication in IG exchange surgery since this information might facilitate a decision in favor of a rechargeable IG.