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An S-shaped incision for the insertion of deep brain stimulators

  • How I Do it - Neurosurgical Techniques
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Abstract

Background

The S-shaped incision is a novel technique we have developed to minimise wound complications for the insertion of bilateral deep brain stimulators.

Methods

An S-shaped incision incorporating both burrholes allows better exposure compared to the traditional bilateral incisions. The burrholes are drilled under each limb of the S and the incision does not run across them, decreasing the risk of infection. The electrodes are subsequently tunneled down the right side and connected to the battery.

Conclusion

The use of the S-shaped incision results in less wound and electrode complications compared to the traditional bilateral linear incisions in our experience.

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Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore

    Lester Lee, John Thomas & Wai Hoe Ng

  2. Neuroscience Academic Clinical Programme, Duke-NUS Graduate Medical School, 8 Collage Road, Singapore, 169857, Singapore

    Lester Lee, John Thomas & Wai Hoe Ng

  3. Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, Singapore, 119077, Singapore

    Siti Rahim

Authors
  1. Lester Lee
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  2. Siti Rahim
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  3. John Thomas
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  4. Wai Hoe Ng
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Corresponding author

Correspondence to Wai Hoe Ng.

Additional information

Comment

The authors describe an S-shaped skin incision incorporating bilateral burr holes during deep brain stimulation (DBS) procedures. They should be commended for concisely and very clearly reporting their technical note and for underscoring the advantage of using a skin flap instead of linear incisions to avoid harmful wound complications.

However, we should consider that the position of the burr holes is not fixed, but must be defined as part of the stereotactic planning to avoid inadvertent passage of the leads through vascular structures or the ventricles while reaching a deep target.

Therefore, to design a bilateral skin incision we should set the stereotactic system with the coordinates of the first site and mark the first entrance point on the skin. Then, we should change the setting of the stereotactic system using the coordinates of the contralateral side and mark the second point. Finally, we should set again the coordinates of the first side to perform the surgical procedure and do the same on the contralateral side.

With some stereotactic systems, this can be a time consuming procedure. We do DBS using two small horseshoe skin flaps that can be independently designed avoiding unnecessary changes of the stereotactic coordinates. Furthermore, to allow a single or two-step tunneling of the leads extensions, we extend the left frontal incision up to the coronal plane of the external acoustic meatus.

Alfredo Conti, MD, PhD

University of Messina, ITALY

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Lee, L., Rahim, S., Thomas, J. et al. An S-shaped incision for the insertion of deep brain stimulators. Acta Neurochir 155, 1671–1674 (2013). https://doi.org/10.1007/s00701-013-1745-6

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  • DOI: https://doi.org/10.1007/s00701-013-1745-6

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