Department of Neurological Surgery, University of Washington Seattle, WA.
Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
Oper Neurosurg (Hagerstown). 2017 Aug 1;13(4):529-534. doi: 10.1093/ons/opx018.
Deep brain stimulation is increasingly used to treat a variety of disorders. As the prevalence of this technology increases, greater demands are placed on neurosurgical practitioners to improve cosmetic results, maximize patient comfort, and minimize complication rates. We have increasingly employed subpectoral implantation of internal pulse generators (IPGs) to improve patient satisfaction.
To determine the complication rates of subpectorally placed IPGs as compared to those placed in a subcutaneous location.
We reviewed a series of 301 patients from a single institution. Complication rates including infection, hematoma, and lead fracture were recorded. Rates were compared for subcutaneously and subpectorally located devices.
Of the records reviewed, we found 301 patients who underwent 308 procedures for initial IPG implantation. Of these, 275 were subpectoral IPG implantation, 19 were infraclavicular subcutaneous implantation, and 14 were subcutaneous implantation in the abdomen. A total of 6 IPG pocket infections occurred, 2 subpectoral and 4 infraclavicular subcutaneous. Of the IPG infections, 2 of the infraclavicular subcutaneous devices had associated erosions. Two patients had their devices relocated from a subpectoral pocket to a subcutaneous pocket in the abdomen due to discomfort. Two patients in the subpectoral group suffered from hematoma requiring evacuation. Two patients in the infraclavicular subcutaneous group had lead fracture occur.
Subpectoral implantation of deep brain stimulation IPGs is a viable alternative with a low complication rate. This technique may offer a lower rate of infection and wound erosion.
深部脑刺激技术越来越多地用于治疗各种疾病。随着该技术的普及，对神经外科医生的要求越来越高，需要改善美容效果、提高患者舒适度并降低并发症发生率。我们越来越多地采用胸肌下植入式内置脉冲发生器（IPG）来提高患者满意度。
比较胸肌下和皮下植入式 IPG 的并发症发生率。
我们回顾了来自一家机构的 301 例患者的系列记录。记录了包括感染、血肿和导联断裂在内的并发症发生率。比较了皮下和胸肌下植入的设备的发生率。
在审查的记录中，我们发现 301 例患者接受了 308 例初始 IPG 植入手术。其中，275 例为胸肌下 IPG 植入，19 例为锁骨下皮下植入，14 例为腹部皮下植入。共发生 6 例 IPG 口袋感染，其中 2 例为胸肌下，4 例为锁骨下皮下。在 IPG 感染中，有 2 例锁骨下皮下设备出现相关侵蚀。由于不适，有 2 例患者将设备从胸肌下口袋转移到腹部皮下口袋。胸肌下组中有 2 例患者出现血肿需要清除。锁骨下皮下组中有 2 例患者发生导联断裂。
深部脑刺激 IPG 的胸肌下植入是一种可行的选择，并发症发生率低。这种技术可能具有更低的感染和伤口侵蚀率。
