The Role of Tissue Expansion in Deep Brain Stimulation Surgery for Parkinson's Disease

Scalp defects (SD) after neurosurgical-procedures in patients with Parkinson's disease (PD) are challenging especially when implants like DBS-leads lie underneath. Tissue expanders (TE) have been widely used in reconstructive surgery. The scanty neurosurgical literature on this topic deals with reconstruction after trauma/multiple craniotomies for neuro-oncological cases. The use of TE for complicated DBS cases has not yet been reported. We illustrate this use with the case of a 60-yr-old male patient. A patient with bilateral STN-DBS for idiopathic PD had undergone a total of 6 revision-procedures due to infections both at the impulse generator (IPG)-site and on the scalp above the DBS-electrodes. Both had to be eventually explanted due to bacterial contamination with an open frontal SD. Worsening of the QoL deemed re-implantation necessary. Occipital implantation of a 200 mL Polytech-TE was followed by gradual tissue expansion in 10 mL-steps over 7 mo with concomitant antibiotics. This was followed by TE-removal, DBS-re-implantation, and rotational-flap-mobilization providing strain-free scalp-closure. Strain-free scalp closure was possible. Planning and carrying out of the DBS was not impeded by the MRI-compatible TE. Combining the DBS-re-implantation and TE-removal during a single general anesthesia (GA) proved feasible. The wound-healing at 180 d was optimal. TEs are feasible for challenging DBS cases with large SDs. There are many important considerations including MRI-compatibility and TE-placement being conducive to frame-based or frameless stereotaxy. Interdisciplinary boards for such cases are indispensable.