Antibiotic Impregnated Catheter Coating Technique for Deep Brain Stimulation Hardware Infection: An Effective Method to Avoid Intracranial Lead Removal.
Antibiotic
DBS
Deep brain stimulation
Hardware complication
Infection
Lead preservationm
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 03 2020
01 03 2020
Historique:
received:
09
05
2018
accepted:
11
02
2019
pubmed:
31
5
2019
medline:
22
6
2021
entrez:
31
5
2019
Statut:
ppublish
Résumé
Few studies have proposed alternative salvage methods of deep brain stimulation (DBS) intracranial lead once the infection has already occurred. To assess the effectiveness of antibiotic impregnated catheter coverage of DBS leads in case of hardware infection. 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). 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 31144720
pii: 5506543
doi: 10.1093/ons/opz118
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
246-253Informations de copyright
Copyright © 2019 by the Congress of Neurological Surgeons.