Occipital nerve stimulator systems: review of complications and surgical techniques

Abstract

Introduction: Stimulation of the occipital nerves is becoming more widely accepted in the treatment of occipital neuritis and migraine disorders. Objective: Presently, equipment available for spinal cord stimulation is adapted for insertion into the subcutaneous space over the occipital nerves. Many technical factors need to be reassessed to optimize the therapy. Methods: We performed a retrospective review of patients implanted from 2003 to 2007 at a single center. We aimed to analyze the rate of surgical complications related to implantation technique. A total of 28 patients were present for analysis. Patients were followed up to 60 months with a mean follow‐up of 21 months. Results: There is a 32% revision rate for electrode migration or displacement, 3.6% removal rate for infection, and a 21% removal rate for lack of efficacy. Although not well studied secondary to small patient populations, this was consistent with a review of the literature which demonstrated a 10–60% revision rate. Other factors such as anchoring strategy, strain relief, and battery location were all considered in the analysis and will be presented. A major determination was that use of a second incision with an additional strain relief loop had only a 10% revision rate of the lead while those without this additional strain relief loop had a 62.5% revision rate. Conclusion: Many technical factors need to be addressed for optimization of occipital nerve stimulation.

Dual occipital and supraorbital nerve stimulation for chronic migraine: a single-center experience, review of literature, and surgical considerations

“…Falowski et al reported that adding a second strain relief loop reduced occipital nerve lead migration from 62.5% to 10%. 5 A midline incision also allows for less migration than a lateral incision by providing space that allows the leads to be tucked up to the thick fascial band in the median raphe. 5 With respect to the battery units, we found the subclavicular location to have fewer incidences of dehiscence, infection, and discomfort from pulling compared with the buttocks location.…”

“…5 A midline incision also allows for less migration than a lateral incision by providing space that allows the leads to be tucked up to the thick fascial band in the median raphe. 5 With respect to the battery units, we found the subclavicular location to have fewer incidences of dehiscence, infection, and discomfort from pulling compared with the buttocks location. With today's availability of small battery packs, even in thin, young female patients, the subclavicular location should be of no significant cosmetic concern.…”

The surgical management of cephalalgia

“…Success rates range from 27 to 100% with pooled analysis showing 68% success of those who tolerated the therapy, not including those patients who were unable to tolerate the stimulator or had removal [45 && ]. The reported revision rate of PNS ranges from 10 to 70%, which includes infection (10%), lead migration (32%), and return to operating room for removal because of patient intolerance or lack of efficacy (21%), though this is likely an underestimation [52]. We do not offer PNS because of high incidence of migration, patient intolerance of the profound paresthesia, and unacceptably high rate of removal.…”

Subcutaneous Occipital Region Stimulation for Intractable Headache Syndromes

“…Migration difficulties are related to anchoring techniques and the fact that these devices were not designed as subcutaneous implant systems. Migration rates as high as 30% have been reported [12,13]. Infection is also technique-dependent and it is important to remember that contaminated skin flora can be implicated in infections that may sometimes present in a delayed fashion.…”