Li Hongyang, Su Daoqing, Lai Yijie, Xu Xinmeng, Zhang Chencheng, Sun Bomin, Li Dianyou, Pan Yixin
Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Neurosci. 2021 Sep 27;15:705483. doi: 10.3389/fnins.2021.705483. eCollection 2021.
Deep brain stimulation (DBS) is a well-established treatment for a variety of movement disorders. Rechargeable cell technology was introduced to pulse generator more than 10 years ago and brought great benefits to patients. However, with the widespread use of rechargeable implanted pulse generators (r-IPGs), a new hardware complication, when charging the r-IPG has been difficult, was encountered. The aims of this study were to report five cases confronted with r-IPG charging difficulty postoperatively and to explore the predisposing factors and treatment strategies for this rare complication. We retrospectively reviewed our DBS patient database for those who were implanted with r-IPGs. From 2012, we identified a total of 1,226 patients, with five of them experiencing charging difficulties after surgery. Detailed patient profiles and clinical procedures were scrutinized and reviewed. All the charging problems were resolved by reoperation. Cases 1 and 2 required their r-IPGs to be anchored to the muscle and fascia. Cases 3 and 4 had their r-IPGs inserted in the wrong orientation at the initial surgery, which was resolved by turning around the r-IPGs at the revision surgery. Case 5, in which we propose that the thick subcutaneous fat layer blocked the connection between the r-IPG and the recharger, required a second operation to reposition the r-IPG in a shallow layer underneath the skin. For all cases, the charging problems were resolved without reoccurrences to date. Our case series indicates a novel hardware complication of DBS surgery, which had been rarely reported before. In this preliminary study, we describe several underlying causes of this complication and treatment methods.
深部脑刺激（DBS）是一种针对多种运动障碍的成熟治疗方法。十多年前，可充电电池技术被引入脉冲发生器，给患者带来了巨大益处。然而，随着可充电植入式脉冲发生器（r-IPG）的广泛使用，出现了一种新的硬件并发症，即给r-IPG充电困难。本研究的目的是报告5例术后出现r-IPG充电困难的病例，并探讨这种罕见并发症的诱发因素和治疗策略。我们回顾性分析了植入r-IPG的DBS患者数据库。从20１2年起，我们共识别出1226例患者，其中5例术后出现充电困难。详细审查了患者资料和临床操作过程。所有充电问题均通过再次手术解决。病例1和病例2需要将r-IPG固定于肌肉和筋膜上。病例3和病例4在初次手术时r-IPG植入方向错误，在翻修手术中通过旋转r-IPG得以解决。病例5中，我们认为是厚厚的皮下脂肪层阻碍了r-IPG与充电器之间的连接，则需要二次手术将r-IPG重新置于皮下浅层。所有病例的充电问题均已解决，至今未再出现。我们的病例系列表明了DBS手术一种新的硬件并发症，此前鲜有报道。在这项初步研究中，我们描述了该并发症的几种潜在原因及治疗方法。
