Postoperative infection problems in DBS applications

Abstract

Deep brain stimulation (DBS) is a significant neuromodulation method for treating neurological and psychiatric disorders. Despite its efficacy, complications, particularly infections, are a concern. This article reviews the prevalence, risk factors, pathogens, infection locations, timing, surgical approaches, prevention strategies, and treatment methods associated with infections following DBS procedures. DBS surgeries have gained popularity due to their adjustability, but infections pose challenges. Surgical site infections (SSIs) are common (0% to 24% cases) and extensively studied regarding patient groups, locations, timing, and pathogens. Expanding patient groups, including conditions like Tourette syndrome and epilepsy, have varying infection risks. Infections occur at burr-hole, extension, and implantable pulse generator (IPG) sites. Staphylococcus aureus is a primary pathogen, yet bacterial DNA on IPGs and colonization complicate understanding. Surgical approaches, staged or non-staged, show comparable infection rates. The influence of repetitive pulse generator replacements on infection rates is debated. Lead externalization, topical vancomycin powder, and other factors impact infection risk. Treating DBS-related infections often requires hardware extraction and antibiotic treatment. Innovations like ethylene oxide sterilization and hydrogen peroxide show potential. Algorithms suggest partial explantation for localized infections. Cost analyses favor starting with antibiotics. Infections persist despite progress; understanding risks, pathogens, and strategies is vital for optimal outcomes in DBS.