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Role of tissue expanders in dbs: a technical note
EANS Academy. Thakur N. 09/25/19; 275309; EP07009
Dr. Nikhil Thakur
Dr. Nikhil Thakur

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Abstract
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Objectives: Scalp defects after neurosurgical procedures are challenging due to potential infections. This problem is greatly aggravated when meticulously implanted electrodes lie underneath. Tissue expanders (TE) are used in plastic-and-reconstructive surgery for a myriad of pathologies. The scanty neurosurgical-literature on TEs deals briefly with reconstruction after multiple-craniotomies for neuro-oncological and post-traumatic cases. The use of TE for complicated DBS patients has not been reported. We discuss the case of a 60-year-old-male patient treated with this method.
Methods: The patient had undergone bilateral STN-DBS-surgery due to idiopathic Parkinson's disease. Six revision-procedures were performed due to infections, both at the site of the implanted-impulse-generator(IPG) and at the level of the scalp directly above the electrodes. These had to be removed due to bacterial-implant-contamination with an open frontal scalp defect. Another DBS-procedure after wound-healing was deemed indispensable. In interdisciplinary-consensus, the occipital implantation of a 200ml-Polytech-TE was performed during the removal of the contaminated implants in addition to postoperative-antibiotic-therapy with amoxicillin/clavulanic acid. The tissue-expansion was gradually achieved in 10ml-steps over 7 months. After sufficient expansion and with no signs of infection, a second DBS-procedure was performed. The TE was removed and a rotational-flap utilised to provide scalp-closure followed by antibiotic-therapy with levofloxacin and clindamycin.
Results: A strain-free scalp-closure was possible. The planning and carrying out of the DBS procedure itself was not impeded by the TE in any way. Combining the implantation of the DBS-electrodes with the removal of the TE during a single GA proved feasible. The wound healing after 90 days has been very satisfactory.
Conclusions: Tissue expansion is a feasible reconstructive method for challenging DBS cases. The placement has to be conducive to frame-based or frameless methods. The TE needs to be MRI-compatible for planning the DBS-leads to avoid additional GA. Interdisciplinary boards for such complex cases are indispensable
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