Department of Neuroscience, Graduate School, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea.
J Parkinsons Dis. 2021;11(3):1465-1469. doi: 10.3233/JPD-212651.
Scalp erosion is not an uncommon complication of deep brain stimulation (DBS) surgery. Although various methods have been proposed to prevent and manage complications, there are still challenges. We introduce a case of recurrent scalp erosion after DBS surgery treated with vacuum-assisted closure.
This article reports the case of a patient who underwent DBS for advanced Parkinson's disease and suffered from recurrent scalp erosion with device extrusion through the skin. Scalp erosion occurred 2 years after DBS and repeated improvement and deterioration despite scalp reconstruction using a skin flap. We opened the wound and performed temporal muscle reconstruction to cover the burr hole site, and we changed the exposed cable and applied vacuum-assisted closure. During the follow-up period, no signs of erosion or infection occurred, and DBS efficacy was preserved.
To date, the available management strategies for scalp erosion after DBS are revision with debridement and scalp reconstruction using skin flaps or skin grafts. However, if erosion occurs repeatedly despite the above management strategies, vacuum-assisted closure with temporalis muscle reconstruction could be a suitable option. We suggest that if the condition of the scalp is weakened, it is worth considering this approach preferentially.
头皮侵蚀是深部脑刺激 (DBS) 手术中并不罕见的并发症。尽管已经提出了各种方法来预防和处理并发症，但仍存在挑战。我们介绍了一例 DBS 术后复发性头皮侵蚀伴器械经皮脱出的病例，采用真空辅助闭合治疗。
本文报告了一例患有晚期帕金森病的患者，在 DBS 术后出现反复头皮侵蚀伴设备经皮脱出。头皮侵蚀发生在 DBS 后 2 年，尽管使用皮瓣进行了头皮重建，但仍反复出现改善和恶化。我们打开伤口并进行颞肌重建以覆盖颅骨钻孔部位，更换暴露的电缆并应用真空辅助闭合。在随访期间，未出现侵蚀或感染迹象，DBS 疗效得以保留。
迄今为止，DBS 后头皮侵蚀的可用治疗策略是清创后revision，并用皮瓣或皮片进行头皮重建。然而，如果尽管采用了上述治疗策略仍反复出现侵蚀，采用颞肌重建的真空辅助闭合可能是一个合适的选择。我们建议，如果头皮状况较弱，值得优先考虑这种方法。
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