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  • Pericranial Flap Over the Hardware as the Enhancement for the Bur Hole Incision Closure in Deep Brain Stimulation (DBS) Surgery

    Final Number:

    Viktoras Palys MD; Kathryn L. Holloway MD

    Study Design:

    Subject Category:
    Functional Neurosurgery

    Meeting: 2016 ASSFN Biennial Meeting

    Introduction: A frontal bur hole provides the traditional cranial access for DBS electrode lead placement. The Medtronic Stimloc is the most commonly used device to secure the lead. This creates a lump under the scalp which is unsightly in balding men as the scalp “shrink wraps” to the hardware. In addition, the risk of hardware erosion (1.24-9.65% reported in literature) and introduction of bacteria to the hardware from a “spitting” stitch may all be related to the lack of protective layer between the scalp skin and DBS hardware. Although the usage of collagen matrix allografts helps with these issues, allografts tend to induce inflammatory response with weeping wounds. We report on a method to utilize the native vascularized tissue to provide protection of the DBS implant and improved cosmesis.

    Methods: While making a straight scalp incision for the bur hole, we preserve the pericranium. A “U” shaped incision is then made in the pericranium which is reflected anteriorly. At the end of surgery, the DBS electrode lead is tunneled to the connector site incision and the residual lead is then coiled around the Stimloc. The pericranial flap is stretched to cover the hardware and is secured around its perimeter with cranial plating screws. The scalp incision is then permanently closed with 4-0 Vicryl interrupted galeal sutures and metal skin staples.

    Results: Since December 2014, with more than 100 implanted DBS electrode leads, we have not observed any instance of DBS hardware erosion or “spitting” stitches leading to the explantation of the hardware. Additionally, the incision closures have been simpler and less costly while the cosmetic results have been better than that achieved with allografts.

    Conclusions: Vascularized tissue autografts have been utilized widely in tissue reconstructive surgeries. Our experience with the application of this technique to DBS surgery has demonstrated advantages over allografts.

    Patient Care: Will decrease the incidence of DBS hardware-related complications.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of proper scalp closure over DBS hardware, 2) Discuss, in small groups, the DBS hardware-related complications and their avoidance 3) Identify the pericranial flap as the vascularized autograft for the bur hole closure.


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