Management of cutaneous scalp complications in deep brain stimulation: illustrative cases.

Background: Scalp complications following deep brain stimulation (DBS) procedures can lead to hardware removal, posing significant clinical and economic challenges. This report describes 3 cases managed with adjacent tissue rearrangement flap and full-thickness skin graft procedures, along with antibiotic therapy.

Observations: Among the 3 cases, 2 patients presented with local infections on initial evaluation. Six months postreconstruction, scalp complications had resolved in 2 patients without interruption to neuromodulation therapy. Of these 2 patients, one had an active infection at the initial presentation.

Lessons: Contrary to the prevailing assumption that DBS hardware should be removed in the presence of scalp complications associated with active infection, the authors' findings suggest that hardware can sometimes be preserved. With comprehensive management, including empirical antibiotic therapy, the authors observed that alternative approaches to hardware removal could be valuable for patients at risk of losing DBS therapeutic benefits. https://thejns.org/doi/10.3171/CASE24833.