Skip to main content
SpringerLink
Log in

Is capsulectomy a feasible and useful measure in internal pulse generator replacement procedures? A technical note on the use of the PEAK PlasmaBladeTM

  • Technical Note - Functional
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

An Erratum to this article was published on 07 April 2017

Abstract

Background

Implantable pulse generator (IPG) replacement is considered a simple procedure, but in case of extension cable damage or IPG pocket infection, it can dramatically affect a patient’s quality of life. Higher risk of infection has been reported after IPG replacement procedures rather than after primary deep brain stimulation lead implantation, and some authors suggested that the IPG pocket capsule could play a pivotal role in causing it. In this technical note we present a capsulectomy technique adopted in IPG replacement procedures.

Methods

Between July and October 2015, we carried out ten outpatient IPG replacement procedures at the chest and abdomen under local anesthesia for battery depletion using the PEAK PlasmaBladeTM. All patients were followed for at least 2 months to rule out any hardware malfunction and infection.

Results

All ten procedures were uneventful. No extension cable damage occurred. No IPG pocket infection occurred, also not in the follow-up. Mean surgical time was 30 min.

Conclusions

Complete capsulectomy is not feasible with basic surgical instruments, and the PEAK PlasmaBladeTM pencil appears to be a helpful tool in carrying out the procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Choksey MS, Malik IA (2004) Zero tolerance to shunt infections: can it be achieved? J Neurol Neurosurg Psychiatry 75(1):87–91

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Choux M, Genitori L, Lang D, Lena G (1992) Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77(6):875–880

    Article  CAS  PubMed  Google Scholar 

  3. Gillies MJ, Joint C, Forrow B, Fletcher C, Green AL, Aziz TZ (2013) Rechargeable vs. nonrechargeable internal pulse generators in the management of dystonia. Neuromodulation 16(3):226–229

    Article  PubMed  Google Scholar 

  4. Korinek A-M, Fulla-Oller L, Boch A-L, Golmard J-L, Hadiji B, Puybasset L (2011) Morbidity of ventricular cerebrospinal fluid shunt surgery in adults: an 8-year study. Neurosurgery 68(4):985–994, discussion 994–5

    Article  PubMed  Google Scholar 

  5. Kypta A, Blessberger H, Saleh K, Hönig S, Kammler J, Neeser K, Steinwender C (2015) An electrical plasma surgery tool for device replacement-retrospective evaluation of complications and economic evaluation of costs and resource use. Pacing Clin Electrophysiol 38(1):28–34

    Article  PubMed  Google Scholar 

  6. Latini F, Sensi M, Preda F, Cavallo MA (2015) How to avoid trivial mistakes during IPG replacement in patients treated with DBS for movement disorders: technical note from 13-years experience. Int J Neurosci 125(10):760–764

    Article  CAS  PubMed  Google Scholar 

  7. Lim KK, Reddy S, Desai S, Smelley M, Kim SS, Beshai JF, Lin AC, Burke MC, Knight BP (2009) Effects of electrocautery on transvenous lead insulation materials. J Cardiovasc Electrophysiol 20(4):429–435

    Article  PubMed  Google Scholar 

  8. Miller JP, Acar F, Burchiel KJ (2009) Significant reduction in stereotactic and functional neurosurgical hardware infection after local neomycin/polymyxin application. J Neurosurg 110(2):247–250

    Article  PubMed  Google Scholar 

  9. Pepper J, Zrinzo L, Mirza B, Foltynie T, Limousin P, Hariz M (2013) The risk of hardware infection in deep brain stimulation surgery is greater at impulse generator replacement than at the primary procedure. Stereotact Funct Neurosurg 91(1):56–65

    Article  PubMed  Google Scholar 

  10. Ruidiaz ME, Messmer D, Atmodjo DY, Vose JG, Huang EJ, Kummel AC, Rosenberg HL, Gurtner GC (2011) Comparative healing of human cutaneous surgical incisions created by the PEAK PlasmaBlade, conventional electrosurgery, and a standard scalpel. Plast Reconstr Surg 128(1):104–111

    Article  CAS  PubMed  Google Scholar 

  11. Thrane JF, Sunde NA, Bergholt B, Rosendal F (2014) Increasing infection rate in multiple implanted pulse generator changes in movement disorder patients treated with deep brain stimulation. Stereotact Funct Neurosurg 92(6):360–364

    Article  PubMed  Google Scholar 

  12. Toia F, D’Arpa S, Cordova A, Moschella F (2015) Exposed subcutaneous implantable devices: an operative protocol for management and salvage. Plast Reconstr Surg Glob Open 3(3):e343

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurosurgery Department, Galeazzi Research and Clinical Hospital, University of Milan, Milano, Italy

    Domenico Servello, Alberto R. Bona & Edvin Zekaj

Authors
  1. Domenico Servello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alberto R. Bona
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edvin Zekaj
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto R. Bona.

Ethics declarations

Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00701-017-3183-3.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Servello, D., Bona, A.R. & Zekaj, E. Is capsulectomy a feasible and useful measure in internal pulse generator replacement procedures? A technical note on the use of the PEAK PlasmaBladeTM . Acta Neurochir 158, 1165–1168 (2016). https://doi.org/10.1007/s00701-016-2793-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-016-2793-5

Keywords

Search

Navigation