One-step tunneling of DBS extensions--a technical note.
Infection constitutes a serious adverse event in deep brain stimulation (DBS) surgery, being responsible for difficult therapeutic decisions that may ultimately involve the removal of implanted material. Some cases begin with skin erosion and wound dehiscence of the retroauricular incision, which is one of the most fragile points. Several techniques of rotation flaps and skin reconstruction, as well as prolonged antibiotic regimens, have been proposed as therapeutic options. To prevent the onset of this complication, the authors propose a one-step tunneling technique of DBS extensions, avoiding the opening of the retroauricular space. We describe a surgical technique of a one-step tunneling of DBS extensions in 20 patients submitted to subthalamic DBS for Parkinson's disease, avoiding the opening of the retroauricular space. After implantation of the extensions using this technique, we had no erosions of the retroauricular skin, with a consequent reduction in the number of infections. The authors describe an easy surgical technique that allows reduction of wound and erosion complications, with great benefits for DBS patients.