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One-step tunneling of DBS extensions—a technical note

  • Technical Note - Neurosurgical Techniques
  • Published:
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Abstract

Background

Infection constitutes a serious adverse event in deep brain stimulation (DBS) surgery, being responsible for difficult therapeutic decisions that may ultimately involve the removal of implanted material. Some cases begin with skin erosion and wound dehiscence of the retroauricular incision, which is one of the most fragile points. Several techniques of rotation flaps and skin reconstruction, as well as prolonged antibiotic regimens, have been proposed as therapeutic options. To prevent the onset of this complication, the authors propose a one-step tunneling technique of DBS extensions, avoiding the opening of the retroauricular space.

Methods

We describe a surgical technique of a one-step tunneling of DBS extensions in 20 patients submitted to subthalamic DBS for Parkinson’s disease, avoiding the opening of the retroauricular space.

Results

After implantation of the extensions using this technique, we had no erosions of the retroauricular skin, with a consequent reduction in the number of infections.

Conclusions

The authors describe an easy surgical technique that allows reduction of wound and erosion complications, with great benefits for DBS patients.

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Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal

    Paulo Linhares, Bruno Carvalho & Rui Vaz

Authors
  1. Paulo Linhares
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  2. Bruno Carvalho
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  3. Rui Vaz
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Corresponding author

Correspondence to Bruno Carvalho.

Additional information

Comment

The subcutaneous positioning of the so-called "extensions", cables connecting the impulse generator with the leads exiting at the frontal bone, is a simple, but time-consuming procedure. An incorrect technique or a complication may compromise results of a complex intracranial procedure, sometimes requiring several days of planning. More importantly, system infection is a complication leading to system removal and return to the preoperative disease status. For this, the authors should be commended for raising the question of the best way to perform this procedure. They suggest performing the positioning of the cables in a one-step cranio-caudal passage. The procedure requires pushing the tunnelizer for a long tract along the cervical region to the sub-clavicular area. Due to the diameter of the tunnelizer, which is large enough to allow the passage of two thick cables, this requires a significant strength, especially at the level of the muscular fascia in the retromastoid area. It is possible to lose control of the instrument during this maneuver, going deep in the muscular plane. Furthermore, the passage of the instrument in the supraclavicular area seems to be more difficult this way.

This article has, however, the merit of focusing our attention on an overlooked step of the DBS procedure. While awaiting for the products of ongoing research on wireless or micro-impulse generators directly implantable on the skull, technical notes on this issue are of definite interest to the functional neurosurgery community.

Alfredo Conti

Messina, Italy

Prior publication/presentation: This work or any portion thereof has not been published or presented in any other journal, conference or seminar.

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Linhares, P., Carvalho, B. & Vaz, R. One-step tunneling of DBS extensions—a technical note. Acta Neurochir 155, 837–840 (2013). https://doi.org/10.1007/s00701-013-1667-3

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  • DOI: https://doi.org/10.1007/s00701-013-1667-3

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