Neuromodulation : journal of the International Neuromodulation Society
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Eddy currents in the metal shell and copper losses in the coils generate heat in rechargeable neurostimulators, which increases the temperature of the adjacent tissue, potentially causing thermal damage of implant patients. Hence, there is an urgent need for a simple self-help method to measure the temperature of such subcutaneous devices. ⋯ A convenient method was then given to monitor the adjacent skin temperature to evaluate the thermal hazards with a skin temperature threshold of 41°C. The proposed approach can be easily implemented by an implant patient at home to reduce the thermal risk, ease patient anxiety, and improve clinical outcomes.
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Case Reports
Cerebral venous infarction: a potentially avoidable complication of deep brain stimulation surgery.
Despite numerous reports on the morbidity and mortality of deep brain stimulation (DBS), cerebral venous infarction has rarely been reported. We present four cases of venous infarct secondary to DBS surgery. ⋯ Cerebral venous infarction is a potentially avoidable, but serious complication. To minimize its incidence, we propose the use of high-resolution, contrast-enhanced, T1-weighted MR images to delineate cerebral venous anatomy, along with careful stereotactic planning of the lead trajectory to avoid injury to venous structures.
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Spinal cord stimulation (SCS) is a well-established modality for the treatment of chronic pain, and can utilize percutaneous or paddle leads. While percutaneous leads are less invasive, they have been shown to have higher lead migration rates. In this study, we compared the long-term outcomes and health-care costs associated with paddle and percutaneous lead implantation. ⋯ While the implantation of paddle leads is associated with slightly higher initial postoperative complications, these leads are associated with significantly lower long-term reoperation rates. Nonetheless, long-term health-care costs are similar between paddle and percutaneous leads. Additional improvements in SCS technologies that address the shortcomings of current systems are needed to reduce the risk of reoperation due to hardware failure. Further study is required to evaluate the efficacy of newer percutaneous and paddle SCS systems and examine their comparative outcomes.
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Case Reports
Silicone septum leakage at the origin of a drug overdose in a patient implanted with an intrathecal pump.
Intrathecal (IT) pump failures usually result in decreased drug administration and symptom reoccurrence with or without withdrawal syndrome. We report a case of a leaking silicone septum associated to a systemic drug overdose. ⋯ This observation is the first description of a silicone septum damage contributing to a pump dysfunction and drug overdose despite the use of appropriate needles for refilling.