Objectives Over 1 50 000 patients have been treated with deep brain stimulation (DBS), but some aspects of their ongoing management are poorly defined. Guidelines for the use of electrocautery in patients undergoing further surgery are vague, suggesting the use of bipolar cautery only. However there is likely to be a safe limit for the use of monopolar electrocautery, a useful if not necessary adjunct for most surgeons. Establishing this would be valuable.
Design Literature review, correspondence with equipment representatives, and animal cadaveric model.
Methods PubMed, the Cochrane Database, and Google Scholar were used for the literature review. Technical team advisers were approached for DBS systems and electrocautery devices. A commercially available freshly slaughtered lamb was prepared in a room with constant ambient temperature. A DBS system was implanted in tandem with a thermocouple at depths and distances matching patient practice. Monopolar electrocautery was employed in coagulation and cutting modes at set distances and levels with constant temperature recording. The implant site was examined microscopically post procedure.
Results The current ‘ban’ on monopolar use appears to be extrapolated from the use of medical diathermy, a very different modality. At no point did the implant site temperature rise more than 2.4°C. Microscopic analysis post procedure revealed no thermal damage.
Conclusions Electrocautery in the context of DBS is safer than previously thought.
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