Introduction: Deep brain stimulation (DBS) is increasingly used to treat a variety of disorders. As the prevalence of this technology increases, greater demands are placed on neurosurgical practitioners to improve cosmetic results, comfort and minimize complication rates. This senior surgeon has increasingly employed subpectoral implantation of internal pulse generators (IPG) to improve patient satisfaction and decrease complication rates.
Methods: A series of 309 patients from a single institution and surgeon were reviewed. Complications including infection, hematoma, painful device location and lead fracture were recorded. Rates were compared for subcutaneously located and subpectorally located devices.
Results: Of the 308 patient records examined, 275 patients had subpectoral IPG implantation, 19 patients had subcutaneous implantation in the chest, and 14 had subcutaneous implantation in the abdomen. A total of 6 IPG pocket infections occurred, 2 subpectoral and 4 subcutaneous in the chest. Of the IPG infections, 2 of the subcutaneous chest devices had associated erosions. Two patients had their devices relocated from a subpectoral pocket to a subcutaneous pocket in the abdomen due to discomfort. One patient had their subpectoral IPG removed because of discomfort and poor patient response to DBS. One patient had their subcutaneous IPG slip into their breast implant pocket and required repositioning to their abdomen. Two patients suffered from hematoma requiring evacuation. Both of these occurred in the subpectoral group. Two instances of lead fracture occurred, both in the subcutaneous group.
Conclusions: Subpectoral implantation of DBS IPGs is a viable alternative that may offer a lower rate of infection and lead fracture. The risk of post-surgical hemorrhage may be greater with subpectoral implantation.
Patient Care: Subpectoral IPG device implantation offers a viable alternative to subcutaneous implantation that may improve patient outcomes by decreasing rates of infection and lead fracture, and improve patient satisfaction by decreasing patient discomfort.
Learning Objectives: Discuss an alternative method for IPG implantation.
Describe rates of DBS infection and other complications.