E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Outsmarting the Troublemaker: A Subpectoral Protocol for Implantable Pulse Generators
Özde Şenol Akbulut✉ ,
Hüseyin Biçeroğlu ,
Bilal Bahadır Akbulut ,
Mustafa Serdar Bölük ,
Ahmet Acarer ,
Taşkın Yurtseven
Department of Neurosurgery, Ege University Faculty of Medicine; Department of Neurosurgery, Bornova Türkan Özilhan State Hospital
DOI: 10.5137/1019-5149.JTN.50930-26.3
Article in Press
Corresponding Author:
Özde Şenol Akbulut (ozde.senol.4@gmail.com)
Abstract
Aim
Hardware-related complications remain a notable concern in deep brain stimulation (DBS) surgeries; infections and erosions account for approximately 5%, with implantable pulse generator (IPG)-related problems accounting for a substantial proportion.. A subpectoral IPG of DBS placement was suggested to be efficient in a previous study. This study aimed to evaluate the safety and effectiveness of a surgical protocol that emphasizes subpectoral IPG placement, assessing its potential to minimize infection and wound complications when implemented at the time of initial implantation.
Material and Methods
A retrospective analysis was conducted on patients who underwent DBS implantation and IPG replacement surgeries by a single surgeon between October 2016 and June 2022. Patients with prior surgeries or follow-ups in other institutions were excluded. Patients were assessed for complications, including infection, wound-healing issues such as skin erosion, hardware exposure, and patient discomfort. Statistical analysis included descriptive statistics to report the incidence of complications during follow-up.
Results
Of 36 patients, 30 were eligible for this study. In total, 53 IPG surgeries were performed, including the initial surgery. No infections or hardware-related erosions were observed throughout the median follow-up period of 5.33 years (2.087.58). One patient (1.89%) with significant comorbidities developed a minor seroma following an IPG replacement surgery, which did not require intervention.
Conclusion
To our knowledge, there is only one other study reporting the results of subpectoral IPG placement prior to this paper. The absence of infections, skin erosions, or wound dehiscence in our series supports placing the IPG under the pectoral muscle from the initial implantation as a promising strategy for DBS surgeries. This approach could contribute to better long-term outcomes.
Hardware-related complications remain a notable concern in deep brain stimulation (DBS) surgeries; infections and erosions account for approximately 5%, with implantable pulse generator (IPG)-related problems accounting for a substantial proportion.. A subpectoral IPG of DBS placement was suggested to be efficient in a previous study. This study aimed to evaluate the safety and effectiveness of a surgical protocol that emphasizes subpectoral IPG placement, assessing its potential to minimize infection and wound complications when implemented at the time of initial implantation.
Material and Methods
A retrospective analysis was conducted on patients who underwent DBS implantation and IPG replacement surgeries by a single surgeon between October 2016 and June 2022. Patients with prior surgeries or follow-ups in other institutions were excluded. Patients were assessed for complications, including infection, wound-healing issues such as skin erosion, hardware exposure, and patient discomfort. Statistical analysis included descriptive statistics to report the incidence of complications during follow-up.
Results
Of 36 patients, 30 were eligible for this study. In total, 53 IPG surgeries were performed, including the initial surgery. No infections or hardware-related erosions were observed throughout the median follow-up period of 5.33 years (2.087.58). One patient (1.89%) with significant comorbidities developed a minor seroma following an IPG replacement surgery, which did not require intervention.
Conclusion
To our knowledge, there is only one other study reporting the results of subpectoral IPG placement prior to this paper. The absence of infections, skin erosions, or wound dehiscence in our series supports placing the IPG under the pectoral muscle from the initial implantation as a promising strategy for DBS surgeries. This approach could contribute to better long-term outcomes.
Keywords
Deep brain stimulation
Implantable pulse generator
Hardware-related
Surgical site infection
Surgical wound dehiscence