title: Postsurgical pathologies associated with intradural electrical stimulation in the central nervous system: design implications for a new clinical device.
abstract: Spinal cord stimulation has been utilized for decades in the treatment of numerous conditions such as failed back surgery and phantom limb syndromes, arachnoiditis, cancer pain, and others. The placement of the stimulating electrode array was originally subdural but, to minimize surgical complexity and reduce the risk of certain postsurgical complications, it became exclusively epidural eventually. Here we review the relevant clinical and experimental pathologic findings, including spinal cord compression, infection, hematoma formation, cerebrospinal fluid leakage, chronic fibrosis, and stimulation-induced neurotoxicity, associated with the early approaches to subdural electrical stimulation of the central nervous system, and the spinal cord in particular. These findings may help optimize the safety and efficacy of a new approach to subdural spinal cord stimulation now under development.
authors.affiliation: Division of Comparative Pathology, Department of Pathology, Carver College of Medicine, University of Iowa, 500 Newton Road, 1167 ML, Iowa City, IA 52242, USA.
authors.forename: Katherine N
authors.initials: KN
authors.lastname: Gibson-Corley
authors.affiliation: Department of Neurosurgery, Carver College of Medicine, University of Iowa, 500 Newton Road, 1167 ML, Iowa City, IA 52242, USA.
authors.forename: Oliver
authors.initials: O
authors.lastname: Flouty
authors.affiliation: Department of Neurosurgery, Carver College of Medicine, University of Iowa, 500 Newton Road, 1167 ML, Iowa City, IA 52242, USA.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Oya
authors.affiliation: Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA 22904, USA.
authors.forename: George T
authors.initials: GT
authors.lastname: Gillies
authors.affiliation: Department of Neurosurgery, Carver College of Medicine, University of Iowa, 500 Newton Road, 1167 ML, Iowa City, IA 52242, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Howard
mesh_terms: D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004566:Electrodes; D006801:Humans; D011183:Postoperative Complications; D013116:Spinal Cord / Q000503:physiopathology / Q000601:surgery; D013117:Spinal Cord Compression