An antibiotic envelope to reduce infections in deep brain stimulation surgery. (January 2023)

• Record Type: Journal Article
• Authors: Primalani, Nishal; Lan, Lee Choon; Ang, Samantha Ya Lyn; Ng, Wai Hoe; Rui, Wan Kai
• Is Part Of: Journal of clinical neuroscience. Volume 107(2023)
• Page Start: 162
• Page End: 166
• Publication Date: 2023-01
• Subjects: Retrospective -- Surgical site infection -- Parkinson's disease -- TYRXTM -- Antibiotic envelope -- Neurosurgery; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2022.10.031
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Surgical site infections in neurosurgery can result in significant morbidity. Retrospective review conducted of all Deep Brain Stimulation surgeries. An antibiotic envelope can prevent the onset of surgical site infections. An antibiotic envelope is therefore a safe and well-tolerated adjunct. No implant removal was required. Abstract: The therapeutic benefits of Deep Brain Stimulation (DBS) surgery in patients with movement disorders such as Parkinson's Disease are life-altering. Surgical site infections (SSI), however, can result in increased hospitalisations, prolonged antibiotics and neurological sequelae. We performed a retrospective review to evaluate the effectiveness of an antibiotic envelope to reduce SSI in DBS surgeries. This study included all DBS surgeries performed between August 2020 to May 2022 using a single-use, multifilament, antibiotic-coated mesh envelope wrapped around the DBS implantable pulse generator (IPG) (TYRX™ Absorbable Antibacterial Envelope, Medtronic Fridley, MN, USA). Standardised infection-prevention measures were applied and various patient-specific and surgery-specific factors were analysed. 44 patients were analysed with 26 (59.1 %) primary implantations and 18 (40.9 %) revision surgeries. The median age was 65 years old with an average follow-up of 13.5 months (range 3–24 months). The mean Body Mass Index was 24.0 (range 16.7–35.6). 8 (18.2 %) patients had underlying diabetes mellitus. There were only 2 (4.5 %) SSIs reported with neither involving the subcutaneous IPG and antibiotic envelope. 1 superficial-incisional SSI (2.3 %) was from a prior retro -auricular abscess around a lead-wire requiring antibiotics and subcutaneous implant transposition. The other was a deep-incisional SSI (2.3 %) from repetitive trauma causing delayed scalp wound dehiscence and lead-wire extrusion, requiring antibiotics and wound revision. Both subjects were discharged well with no implants removed. The antibiotic envelope therefore appears to be a safe and well-tolerated adjunct that may reduce SSIs in DBS surgery. Further prospective work with larger sample sizes in a multi-institution setting is required.