Surgical Management of Deep Brain Stimulator Scalp Erosion without Hardware Removal.

BACKGROUND

Scalp erosion in patients with deep brain stimulation (DBS) hardware is an uncommon complication that lacks a clearly defined management strategy. Previous studies have described various therapies including conservative treatment with antibiotics and surgical debridement with or without hardware removal.

OBJECTIVES

The aim of this study was to review the efficacy of a hardware-sparing management strategy for the treatment of scalp erosion.

METHODS

Five patients with previous DBS implantation presented with scalp erosion and visible hardware exposure at the calvarial burr hole site, and underwent tension-free, vascularized, rotational scalp flap, with preservation of the leads under the pericranium. Two of the procedures were performed after an unsuccessful attempt at primary closure and 3 as a primary procedure. Each patient was followed clinically for at least 14 months postoperatively to evaluate for wound-healing and adverse effects.

RESULTS

The median duration from initial DBS hardware implantation to erosion and revision surgery was 12 months (range 1.5-62 months). Three patients were documented to have positive intraoperative cultures in spite of the absence of purulence. At the last follow-up, all patients were noted to have complete wound-healing and no evidence of infection or erosion.

CONCLUSIONS

DBS scalp erosion can be managed by rotational scalp flap without hardware removal, even in cases where infection is identified.