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  • Non-infectious Erosion of Internal Neurostimulator (INS): Management Without Explantation

    Final Number:
    242

    Authors:
    Zurab Ivanishvili BS, MD; Manish Ranjan MCh; Christopher Honey MD, PhD

    Study Design:
    Other

    Subject Category:
    Functional Neurosurgery

    Meeting: 2016 ASSFN Biennial Meeting

    Introduction: Erosion of an implantable neurostimulator (INS) through the skin usually leads to explantation of the device. In the functional neurosurgical literature erosion complications are commonly reported within the category of infectious complications and no published guidelines are available for their treatment. We propose to differentiate non-infectious erosions from infectious erosions, and to treat the non-infectious erosions surgically without explantation.

    Methods: We describe this hardware-saving procedure in two illustrative cases and review our long-term results in five Deep Brain Stimulation (DBS) patients. We outline the steps in making the diagnosis of non-infectious INS erosion, and provide details of the hardware-saving procedure.

    Results: We were able to save INS in all of the non-infectious erosion cases, without any interruption in the therapeutic stimulation.

    Conclusions: Non-infectious erosion of INS can be identified based on the clinical observation and relevant laboratory tests, and hardware-saving procedure can be employed to save INS. This can save the significant cost associated with replacing the INS and prevent interruptions in the therapeutic stimulation.

    Patient Care: By correctly identifying non-infectious erosion of INS and treating it with the hardware-saving procedure, patients with this diagnosis can be managed without explantation of the device. This will allow uninterrupted therapeutic stimulation and will improve the cost-benefit ratio of the neuromodulaion therapy.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) identify non-infectious erosion cases, 2) perform appropriate diagnostic tests, 3) consider the hardware-saving procedure described in our study.

    References: 1. Oh M, Abosch A, Kim S, Lang A, Lozano A. Long-term hardware-related complications of deep brain stimulation. Neurosurgery 2000;50(6):1268-74 2. Lyons K, Wilkinson S, Overman J, Pahwa R. Surgical and hardware complications of subthalamic stimulation: a series of 160 procedures. Neurology 2004;63(4):612-616 3. Doshi P. Long term surgical and hardware-related complications of deep brain stimulation. Stereotactic and Functional Neurosurgery 2011;89(2):89-95 4. Baddour L, Epstein A, Erickson C, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 2010;121:458-477

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