Transaxillary subpectoral implantation of implantable pulse generator for deep brain stimulation

Objectives: Deep brain stimulation (DBS) is an effective modality of treating cardinal motor symptoms of several movement disorders such as Parkinson's disease, essential tremor, and dystonia. Although hardware-related complications of DBS have been reported, the cosmetic satisfaction and discomfort associated with infraclavicular subcutaneous implantation of the pulse generator has not been described. The authors adopted a technique of transaxillary subpectoral implantable pulse generator (IPG) placement and investigated the difference in the discomfort, cosmetic satisfaction, mean operation time for IPG implantation, and severity of postoperative pain between infraclavicular subcutaneous placement and transaxillary subpectoral implantation of IPG. Materials and Methods: 25 patients who underwent bilateral, infraclavicular subcutaneous IPG placement for DBS and 15 patients who had bilateral, transaxillary subpectoral IPG placement were investigated. Results: The differences in cosmetic satisfaction and discomfort between the two groups were significant. The cosmetic satisfaction was higher and discomfort was less in the subpectoral IPG implantation group (p = 0.002 and p = 0.000). However, more time was needed for IPG implantation, and the postoperative pain was more severe after subpectoral IPG implantation (p = 0.002 and p = 0.000). There was no difference in cosmetic satisfaction according to sex (p = 0.907). There was one transient intercostobrachial nerve injury in the subpectoral IPG implantation group and two infections which needed removal of one side of the DBS hardware in the infraclavicular IPG implantation group. Conclusions: These results demonstrated that subpectoral transaxillary IPG implantation can provide better cosmetic satisfaction in patients undergoing DBS, with less discomfort and morbidity related to erosion and infection.