Charging failure due to pulse generator rotation after deep brain stimulation: a case report

Figures

• 

  Figure 1. Chest CT performed after the initial deep brain stimulation implantation in 2022 demonstrating appropriate positioning of the rechargeable pulse generator (r-IPG) within the right subcutaneous chest pocket. The anterior, coil-facing surface of the device is oriented towards the overlying skin (upper right inset: Actual anterior view of the generator), representing the normal configuration required for efficient transcutaneous charging. The leads exit the device from the left side (white solid arrow) without coiling or displacement. No rotation or migration is identified.

• 

  Figure 2. Chest radiograph obtained at the current admission demonstrating horizontal rotation of the r-IPG within the subcutaneous right chest pocket. The device has undergone approximately 180° of horizontal rotation, with the coil-receiving surface directed posteriorly away from the skin rather than anteriorly towards it, placing the charging coil in direct opposition to the skin and disrupting effective transcutaneous energy transfer. The leads exit the device from the right side (white solid arrow), with no evidence of lead coiling or displacement (white dashed arrow).

• 

  Figure 3. Postoperative chest radiograph following surgical revision demonstrating restoration of normal r-IPG orientation after repositioning and secure fascial anchoring. The coil-receiving surface has been returned to an anterior orientation and the leads exit the device from the left side (white solid arrow). No lead displacement or hardware abnormality is identified.