Deep Brain Stimulator Device Infection: The Mayo Clinic Rochester Experience


 
 
 Deep brain stimulator (DBS)-related infection is a recognized complication that may significantly alter the course of DBS therapy. We describe the Mayo Clinic Rochester experience with DBS-related infections.
 
 
 
 Retrospective study of all adults (≥18-years-old) who underwent DBS-related procedures between 2000-2020 at the Mayo Clinic Rochester.
 
 
 
 There were 1,087 patients who underwent 1,896 procedures. Infection occurred in 57/1,112 (5%) primary DBS implantations and 16/784 (2%) revision surgeries. The median time-to-infection was 2.1 [interquartile (IQR) 0.9, 6.9] months. The Odds of Infection were higher with longer operative length (P-value (P) = 0.002), higher BMI (P = 0.006), male sex (P = 0.041), and diabetes mellitus (P = 0.002). The association between infection and higher BMI (P = 0.002), male sex (P = 0.016), and diabetes mellitus (P = 0.003) remained significant in a subgroup analysis of primary implantations but not revision surgeries. Infection was superficial in 17 (23%) and deep in 56 (77%) cases. Commonly identified pathogens were Staphylococcus aureus (65%), coagulase-negative staphylococci (43%), and Cutibacterium acnes (45%). Three device management approaches were identified: 39 (53%) had complete device explantation, 20 (27%) had surgical intervention with device retention, and 14 (19%) had medical management alone. Treatment failure occurred in 16 (23%) patients. Time-to-event analysis showed fewer treatment failures with complete device explantation (P = 0.015). Only one had complications with brain abscess at failure.
 
 
 
 Primary DBS implantations had higher rates of infection compared to revision surgeries. Complete device explantation was favored for deep infections. However, device salvage was commonly attempted and is a reasonable approach in select cases given the low rate of complications.
