Subsuperficial Pectoralis Fascial Placement of Implantable Pulse Generators in Deep Brain Stimulation Surgery: Technical Note

BACKGROUND AND IMPORTANCE:The second stage of deep brain stimulation requires the placement of an implantable pulse generator (IPG). Although the current placement technique achieves acceptable outcomes, device erosion has been reported. We describe a simple surgical option aimed at increasing device longevity by placing the hardware under the superficial pectoralis fascia.CLINICAL PRESENTATION:We describe and illustrate the technique of placing the IPG in the subfascial space in a patient undergoing deep brain stimulation. In addition, we provide pearls and pitfalls to be mindful of when implementing this method.CONCLUSION:In this technical report, we have outlined a simple alternative approach to the traditional subcutaneous IPG placement by placing the IPG under the superficial pectoralis fascia. This subfascial approach can potentially reduce complications and preserve device longevity.