• Max Ward, Aron Kandinov, Antonios Mammis, Michael Umanoff, and Boris Paskhover.
• Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Electronic address: MaxWard94@gmail.com.
• World Neurosurg. 2018 Nov 1; 119: 300-303.

IntroductionOccipital-frontal nerve stimulation is an off-label therapy for treating chronic refractory migraine and orofacial pain. Though effective, patients experience a high rate of complications including lead migration and erosion through the overlying skin.Case DescriptionWe present a case of frontal electrode erosion that was revised via pericranial flap repair. The patient presented with multiple lead migrations, necessitating multiple revision surgeries with eventual frontal wound dehiscence. The choice was made to wrap the electrode in a pericranial flap to prevent recurrent lead migration. Two weeks postoperatively, the wound was well healed and the patient reported that the midline electrode was functioning properly.DiscussionPericranial flap revision confers little additional risk when compared with simple wound closure, and the surgeon can proceed without total electrode removal, additional incisions, or lead tunneling. The flap provides a highly vascular additional layer of stability to the electrode, reducing the likelihood of further lead exposure without compromising the efficacy of the device. These results suggest that endoscopic pericranial flap revision is a viable technique for the repair of occipital nerve stimulation lead erosions.Copyright © 2018 Elsevier Inc. All rights reserved.

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