Matzel Klaus E, Chartier-Kastler Emmanuel, Knowles Charles H, Lehur Paul A, Muñoz-Duyos Arantxa, Ratto Carlo, Rydningen Mona B, Sørensen Michael, van Kerrebroeck Philip, de Wachter Stefan
Chirurgische Klinik, Universität Erlangen, Germany.
Sorbonne Universités, UPMC, Paris, France.
Neuromodulation. 2017 Dec;20(8):816-824. doi: 10.1111/ner.12695. Epub 2017 Oct 4.
Sacral neuromodulation (SNM) (sacral nerve stimulation SNS) has become an established therapy for functional disorders of the pelvic organs. Despite its overall success, the therapy fails in a proportion of patients. This may be partially due to inadequate electrode placement with suboptimal coupling of the electrode and nerve. Based on these assumptions the technique of sacral spinal neuromodulation has been redefined. All descriptions relate to the only currently available system licensed for all pelvic indications (Medtronic Interstim ).
An international multidisciplinary working party of ten individuals highly experienced in performing SNM convened two meetings (including live operating) to standardize the implant procedure. This report addresses the main steps to optimal electrode lead placement in temporal sequence.
Key elements of the electrode placement are radiological marking, the use of a curved stylet, the entry of the electrode into the sacral foramen and its progression through the foramen, its placement guided by a combination of a typical appearance in fluoroscopy and achieving specific motor/sensory responses with stimulation. The report describes quadripolar electrode placement and then either insertion of a connecting percutaneous extension lead or permanent implantation of the programmable device.
Standardization of electrode placement may ensure close electrode proximity to the target nerve providing a higher likelihood for optimal effect with less energy consumption (better battery longevity), more programming options with more electrode contacts close to the nerve and reduced likelihood of side-effects. The potentially better clinical outcome needs to be demonstrated.
骶神经调节（SNM）（骶神经刺激，SNS）已成为治疗盆腔器官功能障碍的既定疗法。尽管总体上取得了成功，但该疗法在一部分患者中失败。这可能部分归因于电极放置不当以及电极与神经的耦合不理想。基于这些假设，骶神经调节技术已被重新定义。所有描述均涉及目前唯一获得所有盆腔适应症许可的系统（美敦力Interstim）。
一个由十名在进行SNM方面经验丰富的国际多学科工作小组召开了两次会议（包括现场手术），以规范植入程序。本报告按时间顺序阐述了优化电极导线放置的主要步骤。
电极放置的关键要素包括放射学标记、使用弯曲的探条、电极进入骶孔及其在孔内的推进、在荧光镜检查中典型外观与刺激时实现特定运动/感觉反应相结合的引导下进行放置。报告描述了四极电极的放置，然后是连接经皮延长导线的插入或可编程设备的永久植入。
电极放置的标准化可确保电极与目标神经紧密接近，从而更有可能以更低的能量消耗（更好的电池寿命）获得最佳效果，由于更靠近神经的电极触点而有更多的编程选项，以及降低副作用的可能性。潜在的更好临床结果有待证实。
