Hardware Related Complications

Several reports have also focused on hardware complications related to DBS. Beric et al. (46) examined complications for 86 DBS patients and found electrode failure in 3.5% (n = 3), extension wire failure in 4.7% (n = 4), IPG malfunction in 1.2% (n = 1), and pain at the IPG in 1.2% (n = 1). Kondziolka et al. (49) examined hardware complications in 66 patients undergoing unilateral thalamic DBS for either essential tremor, parkinsonian tremor, multiple sclerosis, or other forms of tremor. There were a total of 23 hardware-related complications affecting 27% of the patients. Lead breakage occurred in 10 patients (15.2%), system infection in seven patients (10.6%), connector erosion in two patients (3.0%), and cranial lead migration, chronic subdural hematoma, defective IPG, and a defective connector each in one patient (1.5%, each). Oh et al. (50) reported hardware complications for 79 patients who received 124 DBS implants. DBS was done for PD, essential tremor, pain, epilepsy, dystonia, multiple sclerosis, and Huntington's disease and placed either in the STN, GPi, thalamus, or periventricular gray matter. In total, 20 patients (25.3%) had 26 hardware complications that involved 23 (18.5%) of the devices. More specifically, 5.1% (n = 4) had lead fractures, 5.1% (n=4) had lead migrations, 3.8% (n = 3) had short circuits or open circuits, 15.2% (n = 12) had an infection or device erosion, 2.5% (n = 2) had an allergic reaction, and 1.3% (n = 1) had a cerebral spinal fluid leak. Similarly, Lyons et al. (48)

reported hardware complications from 80 PD patients with 155 DBS implants in the STN. Hardware complications occurred in 26.2% (n = 21) of patients with 10% (n = 8) of patients having complications of the lead or extension wire that required additional neurosurgery and 18.8% (n = 15) of patients having IPG complications that required additional surgery in the subcutaneous tissue of the chest. More specifically, lead fractures occurred in 2.5% (n = 2), lead migrations in 6.3% (n = 5), extension wire fractures in 2.5% (n = 2), extension wire erosions in 1.3% (n = 1), and IPG malfunctions in 13.8% (n = 11). In this report, complications were reduced as the experience of the neurosurgeon was increased.

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