Progress in neurological surgery
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Occipital nerve stimulation may provide pain relief for patients with otherwise refractory primary headache disorders. While this treatment modality remains an off-label use of spinal cord stimulator technology, a growing body of literature documents surgical techniques, stimulation parameters, complications, and outcome of this novel form of neuromodulation. ⋯ A discussion of stimulation parameters used for occipital stimulation will be included. Prospective, blinded studies of occipital nerve stimulation may clarify the role of occipital stimulation in chronic headache management.
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Neuromodulation practitioners increasingly recognize the potential for peripheral nerve field stimulation (PNfS) to treat pain originating from the trunk. Conditions resulting in truncal pain that may respond to PNfS include cervical and lumbar postlaminectomy syndrome, inguinal neurapraxia, post-herpetic neuralgia, and post-thoracotomy pain. The focus of this chapter is to review the mechanism of action in PNfS, patient selection factors, programming strategies, and technical considerations.
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Subcutaneous occipital nerve region stimulation is becoming an important part of the overall treatment regimen for a number of chronic headache syndromes refractory to nonsurgical, medical management. A combination of improved device technology and methodology, further understanding about appropriate indications and achievement of on-label FDA status should support continued use and success of this neuromodulation modality.
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Although commonly used in clinical practice, peripheral nerve stimulation (PNS) for treatment of chronic pain is performed mainly with devices developed and marketed for spinal cord stimulation applications. This may be one of the reasons why PNS approach is marked by a very high complication rate, as the anatomy of peripheral nerves and the surrounding soft tissues is quite different from epidural spinal space for which the current devices are designed. ⋯ Based on the literature data and the analysis of the author's experience with PNS procedures it appears that although the rate of complications is relatively high, the morbidity associated with PNS approach is very minor and most problems may be resolved with simple re-operations, usually on outpatient basis. The reduction in complication rate is expected to occur when the hardware used in PNS procedures is appropriately adapted for PNS applications.
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Peripheral nerve stimulation (PNS) is an established neuromodulation approach that has been successfully used for the treatment of various painful conditions since the early 1960s. This review provides a comprehensive summary of relevant publications on PNS dividing its history into three distinct periods. The milestones of the field are related to the development of procedures, equipment and indications. As the most rapidly growing segment of operative neuromodulation, PNS continues to evolve as current and emerging clinical indications become matched by basic and clinical research, technological developments and procedural refinements.