Hyperbaric Oxygen Therapy as Adjuvant Treatment for Hardware-Related Infections in Neuromodulation

Stereotact Funct Neurosurg. 2018;96(2):100-107. doi: 10.1159/000486684. Epub 2018 Apr 3.


Background: In neuromodulation therapies, hardware-related infections are a major challenge often leading to hardware removal.

Objective: To investigate the role of adjuvant hyperbaric oxygen therapy (HBOT) in hardware-related infections.

Methods: Fourteen hardware-related infection events in 12 consecutive patients between 2002 and 2015 were treated with antibiotics and adjuvant HBOT at the Karolinska University Hospital (Stockholm, Sweden). Two time-independent infection events related to hardware replacements occurred in 2 patients. Infection resolution and the need for hardware removal were assessed.

Results: Twelve out of 14 events of hardware-related infection were successfully treated without hardware removal (86%). The 2 patients treated twice with HBOT on 2 time-independent occasions could retain their hardware in both cases. Hardware was removed following HBOT failure in 2 infection events, with long-term infection control achieved in all patients. Further, an intrathecal pump malfunction caused by HBOT at 2.8 bars was observed, leading to a change in the manufacturer's guidelines.

Conclusions: This study indicates a potential benefit of adjuvant HBOT in the treatment of hardware-related infections in neuromodulation, diminishing the need for hardware removal and treatment interruption. Prospective studies are warranted to establish the role of adjuvant HBOT in the treatment of hardware-related infections in neuromodulation.

Keywords: Deep brain stimulation; Hardware-related infection; Hyperbaric oxygen therapy; Intrathecal baclofen pump; Neuromodulatory devices; Spinal cord stimulation.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage*
  • Child
  • Device Removal / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperbaric Oxygenation / methods*
  • Male
  • Middle Aged
  • Prospective Studies
  • Prosthesis-Related Infections / diagnosis*
  • Prosthesis-Related Infections / therapy*
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult


  • Anti-Bacterial Agents