Department of Neurosurgery, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, UK.
Neuromodulation. 2013 Nov-Dec;16(6):607-9. doi: 10.1111/j.1525-1403.2012.00524.x. Epub 2012 Oct 25.
Occipital nerve stimulation (ONS), an established treatment for medically intractable headache syndromes, has lead migration rates quoted up to 24%. In a series of patients with ideal characteristics for this treatment modality, we describe an operative technique for ONS involving the novel use of narrow paddle electrodes: "S8 Lamitrode" (St. Jude Medical [SJM], St. Paul, MN, USA).
Five patients (occipital neuralgia [ON] = 4; chronic migraine [CM] = 1) were treated with ONS between 2010 and 2011. All patients had a successful trial of peripheral neurostimulation (Algotec Ltd, Crawley, UK) therapy. Operative technique involved the use of a park-bench position, allowing simultaneous exposure of the occipital and infraclavicular regions. Through a retromastoid/occipital incision just beneath the external occipital protruberance, exposing the extrafascial plane, the S8 Lamitrode is implanted to intersect both greater occipital nerves for bilateral pain or unilateral greater and lesser occipital nerves for unilateral ON or with significant component of the pain relating to the lesser occipital nerve.
Over the median follow-up of 12 months, there were no episodes of lead migration or revision. There also was significant improvement in symptoms in all patients.
This is the first reported use of S8 Lamitrode electrode for ONS. This narrow electrode is suited for this role leading to minimal trauma during surgical placement, facilitates resolution of problems with lead migration, and optimizes effect with stimulation focused more in direction of the occipital nerves without skin involvement. To date, the SJM Genesis neurostimulation system, with percutaneous electrodes only, is CE mark approved in Europe for peripheral nerve stimulation of the occipital nerves for the management of pain and disability for patients diagnosed with intractable CM. Further developments and studies are required for better devices to suit ONS, thereby avoiding frequently encountered problems and which may clarify the role of paddle leads in ONS.
枕神经刺激（ONS）是一种成熟的治疗方法，适用于药物难治性头痛综合征，其报道的导丝迁移率高达 24%。我们对一系列具有这种治疗方式理想特征的患者进行了研究，描述了一种涉及新型窄板电极的 ONS 手术技术：“S8 Lamitrode”（圣犹达医疗公司，明尼苏达州圣保罗市，美国）。
2010 年至 2011 年，5 例患者（枕神经痛[ON]=4；慢性偏头痛[CM]=1）接受 ONS 治疗。所有患者均成功进行了外周神经刺激（Algotec Ltd，英国克劳利）治疗试验。手术技术涉及使用公园长椅位置，允许同时暴露枕部和锁骨下区域。通过外耳后/枕部切口，位于外部枕骨突出物下方，暴露筋膜外平面，植入 S8 Lamitrode，以交叉双侧枕大神经用于双侧疼痛或单侧枕大神经和小枕神经用于单侧 ON 或与小枕神经相关的疼痛有明显成分。
中位随访 12 个月，无导丝迁移或修正事件。所有患者的症状均有显著改善。
这是首次报道使用 S8 Lamitrode 电极进行 ONS。这种窄电极非常适合这种作用，在手术放置过程中造成的创伤最小，有助于解决导丝迁移问题，并通过更集中于枕神经方向的刺激来优化效果，而不会涉及皮肤。迄今为止，圣犹达医疗公司的 SJM Genesis 神经刺激系统，仅采用经皮电极，已在欧洲获得 CE 标志批准，可用于刺激枕神经周围神经，以管理诊断为难治性 CM 的患者的疼痛和残疾。需要进一步开发和研究更好的设备来适应 ONS，从而避免经常遇到的问题，并可能阐明 paddel 导联在 ONS 中的作用。
