Peripheral Nerve Stimulation

Editor(s): Slavin K.V. (Chicago, Ill.) 
Table of Contents
Vol. 24, 2011
Section title: Paper
Slavin KV (ed): Peripheral Nerve Stimulation. Prog Neurol Surg. Basel, Karger, 2011, vol 24, pp 96–108

Occipital Nerve Stimulation: Technical and Surgical Aspects of Implantation

Trentman T.L. · Zimmerman R.S. · Dodick D.W.
Departments of aAnesthesiology, bNeurosurgery, and cNeurology, Mayo Clinic, Phoenix, Ariz., USA

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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. This chapter will review occipital nerve stimulation, including surgical techniques and complications noted in the literature. 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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  1. Schwedt TJ, Dodick DW, Hentz J, Trentman TL, Zimmerman RS: Occipital nerve stimulation for chronic headache: long- term safety and efficacy. Cephalalgia 2007;27:153-157
  2. Magis D, Allena M, Bolla M, De Pasqua V, Remacle JM, Schoenen J: Occipital nerve stimulation for drug- resistant chronic cluster headache: a prospective pilot study. Lancet Neurol 2007;6:314-321
  3. Burns B, Watkins L, Goadsby PJ: Treatment of medically intractable cluster headache by occipital nerve stimulation: long- term follow- up of eight patients. Lancet 2007;369:1099-1106
  4. Oh MY, Ortega J, Bellotte JB, Whiting DM, Alo KM: Peripheral nerve stimulation for the treatment of occipital neuralgia and transformed migraine using a C1– 2–3 subcutaneous paddle style electrode: a technical report. Neuromodulation 2004;7:103-112
  5. Weiner RL, Reed KL: Peripheral neurostimulation for the control of intractable occipital neuralgia. Neuromodulation 1999;2:217-221
  6. Melvin EA, Jr, Jordan FR, Weiner RL, Primm D: Using peripheral stimulation to reduce the pain of C2-mediated occipital headaches: a preliminary report. Pain Physician 2007;10:453-460
  7. Hammer M, Doleys DM: Perineuromal stimulation in the treatment of occipital neuralgia: a case study. Neuromodulation 2001;4:47-51
  8. Leone M, Franzini A, Broggi G, Bussone G: Hypothalamic stimulation for intractable cluster headache: long- term experience. Neurology 2006;67:150-152
  9. Slavin KV, Colpan ME, Munawar N, Wess C, Nersesyan H: Trigeminal and occipital peripheral nerve stimulation for craniofacial pain: a single-institution experience and review of the literature. Neurosurg Focus 2006;21:E6
  10. Johnson MD, Burchiel KJ: Peripheral stimulation for treatment of trigeminal postherpetic neuralgia and trigeminal posttraumatic neuropathic pain: a pilot study. Neurosurgery 2004;55:135-141discussion 141– 132
  11. Johnstone CS, Sundaraj R: Occipital nerve stimulation for the treatment of occipital neuralgia – eight case studies. Neuromodulation 2006;9:41-47
  12. Becser N, Bovim G, Sjaastad O: Extracranial nerves in the posterior part of the head. Anatomic variations and their possible clinical significance. Spine 1998;23:1435-1441
  13. Bogduk N: The clinical anatomy of the cervical dorsal rami. Spine 1982;7:319-330
  14. Bogduk N: The anatomy of occipital neuralgia. Clin Exp Neurol 1981;17:167-184
  15. Natsis K, Baraliakos X, Appell HJ, Tsikaras P, Gigis I, Koebke J: The course of the greater occipital nerve in the suboccipital region: a proposal for setting landmarks for local anesthesia in patients with occipital neuralgia. Clin Anat 2006;19:332-336
  16. Doleys DM: Psychological factors in spinal cord stimulation therapy: brief review and discussion. Neurosurg Focus 2006;21:E1
  17. Doleys DM: Psychological assessment for implantable therapies. Pain Digest 2000;10:16-23
  18. Rodrigo- Royo MD, Azcona JM, Quero J, Lorente MC, Acin P, Azcona J: Peripheral neurostimulation in the management of cervicogenic headache: four case reports. Neuromodulation 2005;8:241-248
  19. Kapural L, Mekhail N, Hayek SM, Stanton- Hicks M, Malak O: Occipital nerve electrical stimulation via the midline approach and subcutaneous surgical leads for treatment of severe occipital neuralgia: a pilot study. Anesth Analg 2005;101:171-174
  20. Popeney CA, Alo KM: Peripheral neurostimulation for the treatment of chronic, disabling transformed migraine. Headache 2003;43:369-375
  21. Jones RL: Occipital nerve stimulation using a Medtronic resume II electrode array. Pain Physician 2003;6:507-508
  22. Slavin KV, Nersesyan H, Wess C: Peripheral neuro-stimulation for treatment of intractable occipital neuralgia. Neurosurgery 2006;58:112-119discussion 112– 119
  23. Trentman TL, Zimmerman RS, Dodick DW, Dormer CL, Vargas BB: Occipital nerve stimulator placement under general anesthesia: initial experience with 5 cases and review of the literature. J Neurosurg Anesthesiol 2010;22:158-62
  24. Gofeld M: Anchoring of suboccipital lead: case report and technical note. Pain Pract 2004;4:307-309
  25. Lou L: Uncommon areas of electrical stimulation for pain relief. Curr Rev Pain 2000;4:407-412
  26. Lim HB, Hunt K: Anesthetic management for surgical placement of greater occipital nerve stimulators in the treatment of primary headache disorders. J Neurosurg Anesthesiol 2007;19:120-124
  27. Trentman TL, Mueller JT, Shah DM, Zimmerman RS, Noble BM: Occipital nerve stimulator lead pathway length changes with volunteer movement: an in vitro study. Pain Pract 2010;10:42-48
  28. Trentman TL, Zimmerman RS, Seth N, Hentz J, Dodick DW: Stimulation ranges, usage ranges, and paresthesia mapping during occipital nerve stimulation. Neuromodulation 2008;11:56-61
  29. Trentman TL, Dodick DW, Zimmerman RS, Birch BD: Percutaneous occipital stimulator lead tip erosion: report of two cases. Pain Physician 2008;11:253-256
  30. Anthony M: Headache and the greater occipital nerve. Clin Neurol Neurosurg 1992;94:297-301
  31. Trentman TL, Slavin KV, Freeman JA, Zimmerman RS: Occipital nerve stimulator placement via a retromastoid to infraclavicular approach: a technical report. Stereotact Funct Neurosurg 2010;88:121-125

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