Neuromodulation : journal of the International Neuromodulation Society
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Objectives. This technical report provides a detailed description of a method of transforaminal nerve root stimulation useful in the treatment of chronic pain conditions. Material and Methods. We describe a patient who presented with a medically refractory peripheral neuropathy and suffered from bilateral foot pain. We utilized transforaminal nerve root stimulation to provide robust stimulation paresthesias to the painful areas. ⋯ Results. The patient experienced appropriate pain relief after the stimulation and did not have any complications related to the procedure. Conclusions. We describe a method of transforaminal nerve root stimulation that can be easily implemented by providers using the standard tools available to them. Transforaminal nerve root stimulation may be appropriate for patients in whom more traditional approaches such as spinal cord stimulation or peripheral nerve stimulation are suboptimal.
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Objective. Percutaneous techniques for occipital nerve stimulation have been in the literature since 1999. Lead migration continues to be the most common complication to the technique. The authors would like to introduce a new technique for revision of a superficially migrated occipital nerve stimulator electrode. ⋯ He had no signs of infection and full return of prior function of the stimulator at two weeks and three-month follow-up visits. Conclusion. This case demonstrates a new safer technique for revision of a superficially migrated occipital nerve stimulator lead. The technique is a more direct and simple solution to a common problem in the percutaneous placement of occipital nerve stimulators.
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Objective. The aim of the present study was to describe the surgical and clinical outcomes of the implantation and stimulation of the pedunculopontine tegmental nucleus in humans. Materials and Methods. Fourteen patients affected by movement disorders (12 Parkinson's disease and 2 progressive supranuclear palsy) underwent surgery for bilateral or monolateral implantation of stimulating electrodes in the pedunculopontine tegmental nucleus. The correct placement of electrodes was established and verified by combining angio-CT scans with magnetic resonance imaging. ⋯ The correct positioning of stimulating electrodes in pontine structures such as the pedunculopontine nucleus may be ascertained not only through neuroimaging techniques but also through clinical neurophysiology. The evolution of the surgical planning that we have developed emphasizes the limited value of single-unit recordings to identify the pedunculopontine tegmental nucleus and highlights the opportunities offered by functional evaluations of neurophysiologic parameters. As far as the clinical efficacy is concerned, our data suggest a promising outcome for simultaneous implantations of different basal ganglia nuclei in Parkinsonian and in progressive supranuclear palsy patients as well.
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Introduction. Peripheral nerve stimulation has become a useful tool in neuromodulation in the treatment of chronic and intractable pain syndromes. Method. While most of the reports in the literature describe the use of a subcutaneously placed small diameter cylindric lead, we present a case report of a 37-year-old man who did not have adequate axial back stimulation with such a lead. Conclusion. He had excellent stimulation and reduction of his pain after the device was replaced with an insulated subcutaneous paddle lead.
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Ultrasound-Guided Localization of Difficult-to-Access Refill Port of the Intrathecal Pump Reservoir.
Introduction. Ultrasound guidance is being increasingly utilized in many chronic pain interventions. This is a report of the use of ultrasound imaging for accessing an intrathecal pump. Case Report. A 56-year-old patient with a programmable implanted intrathecal drug delivery system for chronic non-malignant pain needed a pump refill of sufentanil. ⋯ As the patient continued to have a collection of fluid during his following visit, the collection was aspirated under ultrasound guidance. The specimen revealed a proteinaceous collection with minimal quantities of sufentanil. Conclusion. This is a successful demonstration of ultrasound guidance to facilitate access to a difficult-to-access refill port of a pump reservoir secondary to the formation of a seroma.