Review ArticleDeep Brain Stimulation-Related Surgical Site Infections: A Systematic Review and Meta-Analysis
Section snippets
INTRODUCTION
Since the 1980s, deep brain stimulation (DBS) has emerged as an efficient and safe modality for the treatment of movement disorders including Parkinson disease (PD), dystonia, and essential tremor, while additional indications, such as neuropsychiatric disorders (i.e., obsessive–compulsive disorder [OCD], Tourette syndrome) and epilepsy are also being explored (1,2). Currently, the indications of DBS implantation include 28 different disorders across 26 brain targets, whereas it is estimated
Data Sources and Search
The present systematic review and meta-analysis adheres to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Supporting Information Table S1) (15).
We searched for peer-reviewed original research pertaining to the prevalence of SSIs following DBS surgery, as well as to potential risk and preventive factors associated with the risk of DBS-related SSIs. Two reviewers independently searched the MEDLINE database, and potential discrepancies were resolved by
Study Characteristics and Quality Evaluation
The initial literature search in MEDLINE database retrieved 202 articles, of which 88 were evaluated for eligibility following the titles-first and title-and-abstract approaches as shown in the flow chart of the study selection process (Fig. 1). Twenty-two publications were excluded due to specific reasons (Supporting Information Table S2) (20., 21., 22., 23., 24., 25., 26., 27., 28., 29., 30., 31., 32., 33., 34., 35., 36., 37., 38., 39., 40., 41.). Among these studies, three were excluded due
Principal Findings
To our knowledge, this is the largest comprehensive systematic review and meta-analysis including 66 eligible studies from 27 countries (n = 12,258 participants) that examined the association between different indications of DBS and the risk of SSIs. Overall, the summary prevalence of SSIs was estimated at 5.0% (95% CI: 4.0%–6.0%) with higher rates for dystonia (6.5%), as well as for newer indications of DBS, such as epilepsy (9.5%), Tourette syndrome (5.9%), and OCD (4.5%). Similar prevalence
CONCLUSIONS
The present systematic review summarized to-date evidence and comprehensively quantified the prevalence of SSIs for a wide range of indications of DBS surgery. Furthermore, our aim was to assess any potential risk and preventive factor in relation to SSIs. However, our exhaustive search strategy showed that only few risk and preventive measures have been studied to date. Beyond any potential limitations and biases that may affect the summary effect estimates, the findings from the present
Authorship Statements
Dr. Kantzanou and Dr. Karalexi designed and conducted the study, including the systematic literature search of published peer-reviewed articles, data extraction, and data analysis. Dr. Karalexi performed the statistical analysis (quantitative synthesis of evidence) and prepared the manuscript draft with important intellectual input from Dr. Kantzanou and Dr. Panourias. Dr. Korfias, Panourias and Dr. Sakas had complete access to the study data. All authors critically reviewed the manuscript
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Cited by (24)
Use of a Pericranial Flap Technique for Deep Brain Stimulation Hardware Protection and Improved Cosmesis
2023, NeuromodulationCitation Excerpt :Scalp tension, friction against atrophic and/or poorly vascularized skin edges, and focal foreign body reactions can all present pathogenetic factors for early or delayed surgical site complications at the burr-hole cover and/or extension connector locations. Infection of the implanted DBS system components often requires complete or partial explantation of the hardware, followed by prolonged antibiotic treatment, resulting in loss of symptomatic relief.5 In addition, scalp cosmesis is an important consideration.
Infectious Complications of Dorsal Root Ganglion Stimulation: A Systematic Review and Pooled Analysis of Incidence
2022, NeuromodulationCitation Excerpt :When comparing our reported incidence of implant DRGS infections to Hoelzer et al's reported rate, we find that implant DRGS infections are slightly more common. Further, our reported rate is similar to that seen with deep brain stimulation, 2.95% and 5.0%.18,19 As expected, we found statistically significant differences between rates of infection at each stage (trial vs implant vs revision) with infections less common with DRGS trial and more common with DRGS implant.
Brain stimulation and other biological non-pharmacological interventions in mental disorders: An umbrella review
2022, Neuroscience and Biobehavioral ReviewsCitation Excerpt :Using our eligibility criteria, evidence of specific AEs was lacking for other biological non-pharmacological interventions. It would be of interest to define the incidence of specific AEs following DBS, including complications of surgery, such as infections (Kantzanou et al., 2021). The present results should be considered in light of several limitations.
Surgical and Hardware-Related Adverse Events of Deep Brain Stimulation: A Ten-Year Single-Center Experience
2022, NeuromodulationCitation Excerpt :When compared with the literature, the reported incidences are favorable—intracranial AEs, 3.8%; partial or complete hardware removal, 3.6%; and lead revisions, 4.1%. The most common hardware-related AE following initial implantation was SSI (10%), which is higher than the mean SSI incidence described in large systematic reviews of literature (4.7%–5.12%) but within observed ranges (4.45–11.68; 0–15.2).9,10,25 We found no association of selected variables, ie, obesity, smoking, and diabetes mellitus.
Rescuing Infected Deep Brain Stimulation Therapies in Severely Affected Patients
2023, Brain Sciences
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