title: Novel use of narrow paddle electrodes for occipital nerve stimulation--technical note.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, UK.
authors.forename: Kumar
authors.initials: K
authors.lastname: Abhinav
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Park
authors.forename: Savithru K
authors.initials: SK
authors.lastname: Prakash
authors.forename: Sarah
authors.initials: S
authors.lastname: Love-Jones
authors.forename: Nikunj K
authors.initials: NK
authors.lastname: Patel
mesh_terms: D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D058542:Implantable Neurostimulators; D008881:Migraine Disorders / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D009437:Neuralgia / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D010525:Peripheral Nerves; D011859:Radiography; D012886:Skull / Q000000981:diagnostic imaging; D016896:Treatment Outcome
keywords: Lead migration; occipital nerve stimulation; occipital neuralgia