Levi Vincenzo, Messina Giuseppe, Franzini Andrea, Laurenzio Nicola Ernesto Di, Franzini Angelo, Tringali Giovanni, Rizzi Michele
Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
University of Milan, Milan, Italy.
Oper Neurosurg. 2020 Mar 1;18(3):246-253. doi: 10.1093/ons/opz118.
Few studies have proposed alternative salvage methods of deep brain stimulation (DBS) intracranial lead once the infection has already occurred.
To assess the effectiveness of antibiotic impregnated catheter coverage of DBS leads in case of hardware infection.
Patients with a hardware infection and consequent partial removal of extension and internal pulse generator (IPG) were reviewed. To diagnose an infection, criteria provided by the Guideline for Prevention of Surgical Site Infection were used. We compared the intracranial lead salvage rate between the group that underwent antibiotic catheter lead protection (group A) and the group that did not (group B).
A total of 231 DBS surgeries and 339 IPG replacements were performed from January 2012 to January 2017. Twenty-three hardware-related infections (4%) were identified. Nineteen patients (82.6%) underwent partial hardware removal with an attempt to spare intracranial lead. Of these, 8 patients (42.1%) had antibiotic catheter lead coverage (group A) while 11 patients (57.9%) did not receive any antibiotic protection (group B). At 6-mo follow-up, 6 patients had the extension and IPG successfully re-implanted in group A, whereas only 1 patient was successfully re-implanted in group B (75 vs 9.1%; P < .001).
The antibiotic impregnated catheter coating technique seems to be effective in avoiding intracranial lead removal in case of IPG or DBS extension-lead junction infection. This method does not require any surgical learning curve, it is safe and relatively inexpensive. Randomized, prospective, larger studies are needed to validate our results.
很少有研究提出在深部脑刺激（DBS）颅内电极发生感染后可采用的替代挽救方法。
评估在硬件感染情况下，抗生素浸渍导管覆盖DBS电极的有效性。
对发生硬件感染并因此部分移除延长线和植入式脉冲发生器（IPG）的患者进行回顾性研究。采用《外科手术部位感染预防指南》提供的标准来诊断感染。我们比较了接受抗生素导管电极保护的组（A组）和未接受保护的组（B组）的颅内电极挽救率。
2012年1月至2017年1月共进行了231例DBS手术和339次IPG更换。确定了23例与硬件相关的感染（4%）。19例患者（82.6%）进行了部分硬件移除，试图保留颅内电极。其中，8例患者（42.1%）采用了抗生素导管电极覆盖（A组），而11例患者（57.9%）未接受任何抗生素保护（B组）。在6个月的随访中，A组有6例患者成功重新植入了延长线和IPG，而B组只有1例患者成功重新植入（75%对9.1%；P<0.001）。
抗生素浸渍导管涂层技术似乎能有效避免在IPG或DBS延长线-电极连接处感染时移除颅内电极。该方法不需要任何手术学习曲线，安全且相对便宜。需要进行随机、前瞻性、更大规模的研究来验证我们的结果。
