TY - JOUR
T1 - Antibiotic Impregnated Catheter Coating Technique for Deep Brain Stimulation Hardware Infection
T2 - An Effective Method to Avoid Intracranial Lead Removal
AU - Levi, Vincenzo
AU - Messina, Giuseppe
AU - Franzini, Andrea
AU - Laurenzio, Nicola Ernesto DI
AU - Franzini, Angelo
AU - Tringali, Giovanni
AU - Rizzi, Michele
N1 - Publisher Copyright:
Copyright © 2019 by the Congress of Neurological Surgeons.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - BACKGROUND: Few studies have proposed alternative salvage methods of deep brain stimulation (DBS) intracranial lead once the infection has already occurred. OBJECTIVE: To assess the effectiveness of antibiotic impregnated catheter coverage of DBS leads in case of hardware infection. METHODS: Patients with a hardware infection and consequent partial removal of extension and internal pulse generator (IPG) were reviewed. To diagnose an infection, criteria provided by the Guideline for Prevention of Surgical Site Infection were used. We compared the intracranial lead salvage rate between the group that underwent antibiotic catheter lead protection (group A) and the group that did not (group B). RESULTS: A total of 231 DBS surgeries and 339 IPG replacements were performed from January 2012 to January 2017. Twenty-three hardware-related infections (4%) were identified. Nineteen patients (82.6%) underwent partial hardware removal with an attempt to spare intracranial lead. Of these, 8 patients (42.1%) had antibiotic catheter lead coverage (group A) while 11 patients (57.9%) did not receive any antibiotic protection (group B). At 6-mo follow-up, 6 patients had the extension and IPG successfully re-implanted in group A, whereas only 1 patient was successfully re-implanted in group B (75 vs 9.1%; P <. 001) CONCLUSION: The antibiotic impregnated catheter coating technique seems to be effective in avoiding intracranial lead removal in case of IPG or DBS extension-lead junction infection. This method does not require any surgical learning curve, it is safe and relatively inexpensive. Randomized, prospective, larger studies are needed to validate our results.
AB - BACKGROUND: Few studies have proposed alternative salvage methods of deep brain stimulation (DBS) intracranial lead once the infection has already occurred. OBJECTIVE: To assess the effectiveness of antibiotic impregnated catheter coverage of DBS leads in case of hardware infection. METHODS: Patients with a hardware infection and consequent partial removal of extension and internal pulse generator (IPG) were reviewed. To diagnose an infection, criteria provided by the Guideline for Prevention of Surgical Site Infection were used. We compared the intracranial lead salvage rate between the group that underwent antibiotic catheter lead protection (group A) and the group that did not (group B). RESULTS: A total of 231 DBS surgeries and 339 IPG replacements were performed from January 2012 to January 2017. Twenty-three hardware-related infections (4%) were identified. Nineteen patients (82.6%) underwent partial hardware removal with an attempt to spare intracranial lead. Of these, 8 patients (42.1%) had antibiotic catheter lead coverage (group A) while 11 patients (57.9%) did not receive any antibiotic protection (group B). At 6-mo follow-up, 6 patients had the extension and IPG successfully re-implanted in group A, whereas only 1 patient was successfully re-implanted in group B (75 vs 9.1%; P <. 001) CONCLUSION: The antibiotic impregnated catheter coating technique seems to be effective in avoiding intracranial lead removal in case of IPG or DBS extension-lead junction infection. This method does not require any surgical learning curve, it is safe and relatively inexpensive. Randomized, prospective, larger studies are needed to validate our results.
KW - Antibiotic
KW - DBS
KW - Deep brain stimulation
KW - Hardware complication
KW - Infection
KW - Lead preservationm
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U2 - 10.1093/ons/opz118
DO - 10.1093/ons/opz118
M3 - Article
C2 - 31144720
AN - SCOPUS:85079342521
VL - 18
SP - 246
EP - 253
JO - Operative Neurosurgery
JF - Operative Neurosurgery
SN - 2332-4252
IS - 3
ER -