Effectiveness of salvage procedures for functional neurosurgical cranial implants: a single center review

Introduction: In the setting of wound dehiscence or infection, neurosurgical cranial implants, including deep brain stimulation (DBS) and responsive neurostimulation (RNS) systems, are typically recommended to be completely explanted. However, limited data exist regarding the effectiveness of salvage procedures in which wound revision is undertaken without device explantation.

Methods: Medical records for patients with DBS or RNS devices implanted at our institution between 2015-2023 were reviewed for wound dehiscence or infection.  Procedural success was defined as definitive management of the presenting complication without the need for subsequent device explantation.

Results: 247 patients underwent DBS (235/247, 95.1%) or RNS (12/247, 4.9%) device implantation during this period.  23/247 (9%; 21 DBS and 2 RNS) patients developed wound dehiscence or infection, including 10/23 (43%) patients with poor wound healing without evidence of deep infection or hardware contamination and 13/23 (57%) patients with evidence of deep infection or hardware contamination.  Of the 10 patients with poor wound healing without evidence of deep infection or hardware contamination, 10/10 (100%) patients underwent wound revision without device explantation, and 8/10 (80%) of these cases were successful, while 2/10 (20%) of cases required subsequent partial or complete explantation. Of the 13 patients with evidence of deep infection or hardware contamination, 3/13 (23%) patients underwent complete hardware explantation without needing further surgical intervention to treat the infection.  10/13 (77%) patients underwent partial explantation, and 5/10 (50%) cases were successful, while the other 5/10 (50%) cases required subsequent complete explantation.

Conclusion : In patients with implanted neurostimulation systems (DBS or RNS), superficial wound dehiscence without evidence of deep infection or hardware contamination may effectively be managed with local wound revision without device explantation. Those with evidence of deep infection or hardware contamination are more likely to ultimately require complete hardware explantation, but a significant fraction may not.  Larger studies are needed to validate these observations.