Updated management of occipital nerve stimulator lead migration: case report of a technical challenge

AbstractElectrode migration is a challenge, even with adequate anchoring techniques, due to the high mechanical stress on components of occipital nerve stimulation (ONS) for headache disorders. When a lead displacement of an ONS implant is diagnosed, there are currently different approaches described for its management. Nevertheless current neuromodulation devices are designed like a continuum of components without any intermediate connector, and if a lead displacement is diagnosed, the solution is the complete removal of the electrode from its placement, and its repositioning through an ex-novo procedure. The described technique can allow ONS leads to be revised while minimizing the need to reopen incisions over the IPG, thus improving patients’ intraoperative and postoperative discomfort, shortening surgical time and medical costs, reasonably reducing the incidence of infective postoperative complications.

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Percutaneous nerve field stimulation (PENS) of the occipital region as a possible predictor for occipital nerve stimulation (ONS) responsiveness in refractory headache disorders? A feasibility study

Cephalalgia ◽

10.1177/0333102415613765 ◽

2015 ◽

Vol 36 (8) ◽

pp. 779-789 ◽

Cited By ~ 10

Author(s):

TM Kinfe ◽

B Pintea ◽

S Roeske ◽

Á Güresir ◽

E Güresir ◽

...

Keyword(s):

Nerve Stimulation ◽

Field Stimulation ◽

Headache Disorders ◽

Occipital Nerve Stimulation ◽

Stimulation Threshold ◽

Occipital Nerve ◽

Refractory Headache ◽

Headache Severity ◽

Disability Scale ◽

Different Origin

Background Occipital nerve stimulation (ONS) has been reported to diminish pain levels in intractable chronic headache syndromes of different origin. No reliable objective markers exist to predict ONS responsiveness. This study investigated the predictive value of occipital percutaneous nerve field stimulation (PENS) prior to ONS. Methods This trial included 12 patients (CCH, CM, PTH, CH) with chronic refractory headache syndromes eligible for ONS. Repetitive PENS (3 × /10 days) was performed and the headache severity/frequency monitored over four weeks before ONS implantation. Further assessment of PENS/ONS outcomes were stimulation-related complications, perception/tolerance stimulation threshold, the Migraine Disability Scale (MIDAS) and the Beck Depression Inventory (BDI). Results All PENS responders benefited from ONS. Of the seven PENS-nonresponders with VAS 6.1(±1.1), six experienced significant pain relief from ONS after three months and one patient failed the PENS/ONS trial (VAS 3.7 (±1.6)); (95% CI 3.6 to 5.7, p < 0.001). The VAS baseline was 8.4 (±0.5) and decreased significantly (50% reduction in severity/frequency) in five patients after PENS, while seven failed to improve (VAS 4.9 (±1.1); (95% CI 2.5 to 4.5, p < 0.001). BDI baseline (from 22.6 (±4.2) to 10.6 (±5.9) (95% CI 7.4 to 16.6, p < 0.001)) and MIDAS baseline (from 143.9 (±14.5) to 72.8 (±28.7) (95% CI 1.17 to 2.3, p < 0.001)) significantly declined after ONS. No PENS/ONS-related complications occurred. Conclusions Presurgical applied occipital PENS failed to identify ONS responders sufficiently according to our study protocol, thus requiring further specific investigations to determine its predictive usefulness.

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Successful Treatment of Chemotherapy‐Induced Headaches With Occipital Nerve Stimulation: A Case Report

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.13077 ◽

2019 ◽

Vol 23 (6) ◽

pp. 881-882 ◽

Cited By ~ 1

Author(s):

Alaa Abd‐Elsayed ◽

Natalie Pahapill

Keyword(s):

Case Report ◽

Successful Treatment ◽

Nerve Stimulation ◽

Occipital Nerve Stimulation ◽

Occipital Nerve

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Occipital nerve stimulation for intractable chronic cluster headache or migraine: A critical analysis of direct treatment costs and complications

Cephalalgia ◽

10.1177/0333102413493193 ◽

2013 ◽

Vol 33 (16) ◽

pp. 1283-1291 ◽

Cited By ~ 47

Author(s):

Oliver Mueller ◽

Hans-Christoph Diener ◽

Philipp Dammann ◽

Kasja Rabe ◽

Vincent Hagel ◽

...

Keyword(s):

Cluster Headache ◽

Nerve Stimulation ◽

Chronic Cluster Headache ◽

Treatment Costs ◽

Headache Disorders ◽

Occipital Nerve Stimulation ◽

Occipital Nerve ◽

Primary Headache Disorders ◽

Direct Treatment ◽

Hospitalization Costs

Background Occipital nerve stimulation (ONS) has been shown to be effective for selected patients with intractable headache disorders. We performed a prospective critical evaluation of complications and direct treatment costs. Methods Twenty-seven patients with chronic cluster headache (CCH, n = 24) or chronic migraine (CM, n = 3) underwent a trial phase with bilateral ONS and subsequent implantation of a permanent generator (IPG), if responsive to treatment according to predefined criteria. Procedural and long-term complications as well as direct treatment costs of neuromodulation therapy of ONS were recorded over a mean follow-up period of 20 months (range 5–47 months). Results Twenty-five of 27 patients (93%) responded to treatment. Twenty-one complications in 14 patients were identified, necessitating reoperation in 13 cases. Overall treatment costs were €761,043, including hardware-related costs of €506,019, costs for primary hospital care of €210,496, and complications related to hospitalization costs of €44,528. This results in a per case-based cost of €9445 for hospitalization and €18,741 for hardware costs, totaling €28,186. Conclusion ONS for treatment of refractory CCH and CM is a cost-intensive treatment option with a significant complication rate. Nevertheless, patients with refractory primary headache disorders may experience substantial relief of pain attacks, and headache days, respectively.

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