Deep brain stimulator hardware-related infections: Incidence and management in a large series

OBJECTIVE: Device-related infection is a common complication of deep brain stimulator (DBS) implantation. We reviewed the incidence and management of early hardware-related infections in a large series. METHODS: All patients undergoing DBS implantation surgery between 1998 and 2006 at a single institution were entered into a prospectively designed database. After database verification by cross-referencing manufacturer implantation records, a query was performed to include all new Medtronic (Minneapolis, MN) implantations performed with standard operating room technique. Hardware-related infections requiring further surgery were identified, and charts were reviewed to assess the success of lead-sparing partial hardware removal in this group. RESULTS: Four hundred twenty patients received 759 new DBS electrodes and 615 new internal pulse generators for the treatment of movement disorders or pain. Nineteen patients (4.5%) had an early (<6 mo) hardware-related infection requiring further surgery. There were no intracranial infections. Four patients presented with extensive cellulitis or wound dehiscence and were treated with total hardware removal. Fourteen patients presented with more localized infections and were treated by removal of the involved components only, followed by intravenously administered antibiotics. In nine of these patients, partial hardware removal successfully resolved the infection without requiring removal of the DBS electrodes. Wound washout alone was attempted in one patient and failed. CONCLUSION: In a large series of new DBS hardware implantations, the incidence of postoperative hardware-related infection requiring further surgery was 4.5%. When only one device component was involved, partial hardware removal was often successful.