Introduction: We present a 61 years-old female patient, with a 23 years history of Parkinson's disease, who underwent implantation deep brain stimulation in the subthalamic nucleus (STN). The patient unfortunately developed one year after surgery a bilateral subcutaneous and skin infection at the insertion in the scalp. She was treated with multiple antibiotic therapy presenting partial improvement and it was necessary to remove the leads.
Methods: Stereotactic surgery to redeploying the leads was proposed due to the quality of life improvement achieved after DBS, however in order to avoid the same entry point or any vicinity to the formed infected area, the parietal access was proposed to target the STN. Electrophysiological mapping was performed bilaterally. Microelectrode recording showed a lost of signal which we believe corresponded to the former space occupied by the first electrode.
Results: Significant improvement in UPDRS motor score (63%) was obtained with bilateral stimulation 4 months after re-operation using one contact of the lead, versus UPDRS motor score of 46% after previously DBS implanted.
Conclusions: Parietal access is a viable option to access the STN in post-infection cases and may even become a primary entry point for implantation of DBS electrodes in the STN since it may allow a major STN stimulation area.
Patient Care: We can make the same result in UPDRS improvement by parietal approach with DBS and MER techniques for patients with previous skin infection, before forward him to others treatment such as lesioning or radiosurgery.
Learning Objectives: Describe the importance of treatment option in case of DBS skin infection site, such as show the parietal entry point possibility.