• Oper Neurosurg (Hagerstown) · Mar 2020

    Antibiotic Impregnated Catheter Coating Technique for Deep Brain Stimulation Hardware Infection: An Effective Method to Avoid Intracranial Lead Removal.

    • Vincenzo Levi, Giuseppe Messina, Andrea Franzini, LaurenzioNicola Ernesto DiNEDUniversity of Milan, Milan, Italy., Angelo Franzini, Giovanni Tringali, and Michele Rizzi.
    • Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
    • Oper Neurosurg (Hagerstown). 2020 Mar 1; 18 (3): 246-253.

    BackgroundFew studies have proposed alternative salvage methods of deep brain stimulation (DBS) intracranial lead once the infection has already occurred.ObjectiveTo assess the effectiveness of antibiotic impregnated catheter coverage of DBS leads in case of hardware infection.MethodsPatients 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).ResultsA 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).ConclusionThe 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.Copyright © 2019 by the Congress of Neurological Surgeons.

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