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Neurological Surgery No Shinkei Geka Volume 47, Issue 10 （October 2019）

Neurological Surgery 脳神経外科 47巻10号（2019年10月発行）

Japanese English

研究

脳深部刺激手術における術後デバイス関連感染の検討 Analysis of Device-Related Infection after Deep Brain Stimulation Surgery 小座野いづみ ^1,3 , 川崎隆 ¹ , 濱田幸一 ^1,4 , 木村活生 ² , 岸田日帯 ² , 岡村泰 ⁵ , 樋口優理子 ⁶ , 浦丸浩一 ¹ , 坂田勝巳 ¹ , 山本哲哉 ⁷ Izumi KOZANO ^1,3 , Takashi KAWASAKI ¹ , Kouichi HAMADA ^1,4 , Katsuo KIMURA ² , Hitaru KISHIDA ² , Yasushi OKAMURA ⁵ , Yuriko HIGUCHI ⁶ , Koichi URAMARU ¹ , Katsumi SAKATA ¹ , Tetsuya YAMAMOTO ⁷ ¹横浜市立大学附属市民総合医療センター脳神経外科 ²横浜市立大学附属市民総合医療センター神経内科 ³小田原市立病院脳神経外科 ⁴神奈川県立足柄上病院脳神経外科 ⁵東京都立松沢病院精神科 ⁶汐田総合病院脳神経外科 ⁷横浜市立大学大学院医学研究科脳神経外科学 ¹Department of Neurosurgery, Yokohama City University Medical Center ²Department of Neurology, Yokohama City University Medical Center ³Department of Neurosurgery, Odawara Municipal Hospital ⁴Department of Neurosurgery, Kanagawa Prefectural Ashigarakami Hospital ⁵Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital ⁶Department of Neurosurgery, Ushioda General Hospital ⁷Department of Neurosurgery, Graduate School of Medicine, Yokohama City University キーワード： device-related infection , risk factor , two stages , period between surgeries Keyword: device-related infection , risk factor , two stages , period between surgeries pp.1037-1043

発行日 2019年10月10日 Published Date 2019/10/10

DOI https://doi.org/10.11477/mf.1436204070

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Ⅰ．緒　　言

　脳深部刺激療法（deep brain stimulation：DBS）はパーキンソン病，本態性振戦，ジストニア等の運動異常症に対する治療法として確立している．その一方で，手術による合併症は機能外科という性格上，ひとたび発生すると重大な問題となることが多い．特に感染は，異物を埋め込むためしばしば難治性となり，埋め込んだデバイスを除去せざるを得なくなることもある．今回，当施設でのDBS症例について，術後の感染例を検討した．

　BACKGROUND:Device-related infection frequently becomes a serious problem after deep brain stimulation（DBS）surgery and DBS device removal is usually the only effective treatment option. In this study, we examined risk factors for infection related to DBS devices at our institution.

　METHODS:We retrospectively investigated 80 DBS surgeries performed between March 2009 and September 2017 at our institution. We examined the relationship between DBS device-related infection and the following items:duration of electrode placement surgery, total number of tracks of microelectrode recordings（MER), period between surgeries, highest body temperature until implantable pulse generator（IPG）implantation, and patient background characteristics.

　RESULTS:Four（5.0%）patients developed device-related infection after DBS surgery. Three of them required device removal, whereas one improved following antibiotic treatment alone. We did not identify any specific trend or risk factor for infection.

　DISCUSSION:We perform DBS surgery in two stages. Patients were implanted with an IPG 2-3 days after electrode placement until August 2016, and at 6-8 days starting in September 2016. All cases of infection developed before September 2016, and no cases of infection have occurred since September 2016. We believe that lengthy surgical electrode placement affects the general status of patients and performing surgery before stabilization might confer a risk of infection.

　CONCLUSION:Device-related infection after DBS surgery does not seem to be associated with any risk factors. However, a shorter period between two-staged surgeries might affect infection rates.