title: Peripheral nerve stimulation by 'sandwich' paddle leads: technical note.
abstract: BACKGROUND
  Recently, there has been a burgeoning interest in the utility of peripheral nerve stimulation (PNS) for a variety of chronic focal neuropathic, musculoskeletal and visceral pain conditions. If the source of pain is directly related to a single peripheral nerve, surgical exposure and placing a paddle lead on the nerve are most effective.
  
  
  METHODS
  In this report, we describe a novel technique that optimizes the peripheral nerve stimulation by two paddle leads placed on either side of the nerve with their stimulating surfaces in contact with the nerve. After appropriate prepping and draping, the selected nerve is localized and circumferentially dissected free from the adjacent soft tissue. There should be enough length of nerve to accommodate two On-Point quadripolar leads (Medtronic, MN) along the length of the nerve in the same direction.
  
  
  RESULTS
  This 'sandwich' technique provides a wider interface of contacts with nerve fibers. It reduces the chance of migration and provides an opportunity for 'crosstalk.'
  
  
  CONCLUSIONS
  In selected cases where an open surgical PNS lead needs to be placed, the 'sandwich' technique can be used to augment the stimulation without additional morbidity. Although occasionally used in practice, this technique is still unreported.
authors.affiliation: Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK, amitkalpana@aol.com.
authors.forename: Amit
authors.initials: A
authors.lastname: Amit
authors.forename: Mayur
authors.initials: M
authors.lastname: Sharma
authors.forename: Milind
authors.initials: M
authors.lastname: Deogaonkar
mesh_terms: D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D058542:Implantable Neurostimulators; D009437:Neuralgia / Q000628:therapy*; D010523:Peripheral Nervous System Diseases / Q000628:therapy*