Ughratdar Ismail, Kawsar Khandkar Ali, Mitchell Rosalind, Selway Richard, Ashkan Keyoumars
Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom.
World Neurosurg. 2018 Apr;112:31-36. doi: 10.1016/j.wneu.2018.01.007. Epub 2018 Jan 9.
Battery replacement or revision surgery for neuromodulation implants is conventionally performed using sharp dissection. Meticulous dissection within thick scar tissue is vital to avoid damage to surrounding lead(s), which could result in more extensive revision surgery. Traditional electrosurgery devices are contraindicated as the emitted energy can be transferred to the hardware, resulting in implant or tissue damage with severe consequent complications.
We report our experience and potential applications of a novel, pulsed monopolar radiofrequency energy device (PEAK PlasmaBlade, Medtronic PLC, Minneapolis, Minnesota, USA), which facilitates dissection around implants without the risk of damaging or transmitting energy through the system.
We conducted a 2-center retrospective study to review the indications, safety, and efficacy of the PlasmaBlade in 57 cases requiring either neuromodulation system replacement or revision. Deep brain stimulator (DBS) battery replacements were undertaken in 45 cases, 8 vagal nerve stimulator battery revisions, 2 intrathecal baclofen system revision, 1 DBS extension revision, and 1 DBS scar revision around the cranial portion of the lead.
All cases proceeded without adverse event or damage to lead/generator and with a subjective and objective impression of significant time savings. Average operating times for battery replacements were reduced from 37 to 26 minutes (P = 0.015).
In our experience, the PlasmaBlade is safe to use in revising/replacing neuromodulation implants. We observed no damage or transmission of energy to the implants or leads; additional advantages of the system include reduced operating times, less damage to surrounding tissue, and the potential to facilitate revision procedures in awake patients under local anesthesia.
神经调节植入物的电池更换或翻修手术传统上采用锐性分离。在厚瘢痕组织内进行细致分离对于避免损伤周围的导线至关重要，否则可能导致更广泛的翻修手术。传统的电外科设备是禁忌的，因为所发射的能量可传递至硬件，导致植入物或组织损伤并引发严重的并发症。
我们报告一种新型脉冲单极射频能量设备（PEAK PlasmaBlade，美敦力公司，美国明尼苏达州明尼阿波利斯）的应用经验及潜在用途，该设备有助于在植入物周围进行分离，而不会有损坏系统或通过系统传递能量的风险。
我们进行了一项双中心回顾性研究，以评估PlasmaBlade在57例需要更换或翻修神经调节系统的病例中的适应证、安全性和有效性。其中45例进行了脑深部电刺激器（DBS）电池更换，8例进行了迷走神经刺激器电池翻修，2例进行了鞘内巴氯芬系统翻修，1例进行了DBS延长线翻修，1例进行了导线颅骨部分周围的DBS瘢痕翻修。
所有病例均顺利进行，未发生不良事件，也未对导线/发生器造成损伤，并在主观和客观上均感觉显著节省了时间。电池更换的平均手术时间从37分钟减少至26分钟（P = 0.015）。
根据我们经验，PlasmaBlade用于翻修/更换神经调节植入物是安全的。我们未观察到能量对植入物或导线造成损伤或传递；该系统的其他优点包括缩短手术时间、减少对周围组织的损伤以及有可能便于在局部麻醉下对清醒患者进行翻修手术。
