Revision of Occipital Nerve Stimulator Leads: Technical Note of Two Techniques

Objective:  Occipital nerve stimulation can be effective therapy for recalcitrant headache disorders. Lead migration remains the primary technical adverse event associated with this therapy. Revision surgery for occipital nerve stimulator leads sometimes requires exposure of all components including...

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Published inNeuromodulation (Malden, Mass.) Vol. 15; no. 4; pp. 387 - 391
Main Authors Zimmerman, Richard S., Rosenfeld, David M., Freeman, John A., Rebecca, Alanna M., Trentman, Terrence L.
Format Journal Article
LanguageEnglish
Published Malden, USA Blackwell Publishing Inc 01.07.2012
Subjects
Electric Stimulation Therapy - instrumentation
Electric Stimulation Therapy - methods
Electrode placement
Electrodes, Implanted - adverse effects
Foreign-Body Migration
Headache
Headache Disorders - therapy
Humans
implantation
Infection
Invasiveness
Lead
lead migration
Migration
Needles
Nerves
occipital nerve stimulation
Prosthesis Implantation - methods
Reoperation - methods
Spinal Nerves - physiology
Surgery
Surgical Instruments
Treatment Outcome
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Summary:Objective:  Occipital nerve stimulation can be effective therapy for recalcitrant headache disorders. Lead migration remains the primary technical adverse event associated with this therapy. Revision surgery for occipital nerve stimulator leads sometimes requires exposure of all components including internal pulse generator, extension cables, connectors, and leads with multiple incisions. However, minimizing the invasiveness of revision surgery reduces the time, infection risk, and discomfort associated with the procedure. We describe two techniques that attempt to minimize the extent of revision surgery necessary for lead migration. Materials and Methods:  We describe two minimally invasive revision techniques. One uses a 14‐gauge Tuohy needle converted to a slotted needle. The other uses a standard Tuohy needle inserted subcutaneously into the anchor site along the desired course of the lead. Results:  Both techniques allow replacement of a migrated occipital nerve stimulator lead while eliminating the need to access connector or battery sites with multiple incisions. Conclusions:  When migration occurs, the techniques described can simplify lead revision while minimizing the invasiveness of the procedure.
Bibliography:ark:/67375/WNG-F7236Z4C-P
ArticleID:NER413
istex:F6FA60B0229271C5CBA65DB9981CCC78AD7326BE
http://www.wiley.com/bw/submit.asp?ref=1094‐7159&site=1
Financial disclosures: Drs. Trentman, Rebecca, and Zimmerman have received research support from St. Jude Neuromodulation; Drs. Trentman and Zimmerman have received research support from Medtronic Inc. and Advanced Bionics Inc., now Boston Scientific Neuromodulation.
The authors have no financial interest in the material or devices described in this article and received no financial support in generation of this manuscript.
For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to
Authorship Statement: All authors contributed to the concepts described herein and assisted with manuscript preparation. Each approved the final manuscript.
Conflict of Interest
The authors report no conflicts of interest.
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ISSN:1094-7159
1525-1403
DOI:10.1111/j.1525-1403.2011.00413.x