Spinal Cord Stimulation Paddle-to-Percutaneous Revision: Case Series and Technical Description.

OBJECTIVE: Spinal cord stimulators (SCSs) can be implanted via a percutaneous or paddle approach, the latter technique requiring a laminotomy or laminectomy. Revision surgery may be necessary in instances of migrated, misplaced, or failed stimulators. When revision of a percutaneous system is necessary, it is common to replace the electrodes with a paddle SCS. This study aims to describe a case series of patients with failed paddle SCS electrodes who underwent revision with percutaneous SCS hardware. METHODS: A series of 5 patients were retrospectively analyzed. Medical records were reviewed for demographic data, operative technique, postoperative follow-up, and complications. RESULTS: Five patients were included in this series. The median age was 63 (range 51-84), and the median duration from initial implantation to revision surgery was 19 months (range 5-60). The median operative duration was 92 minutes (mean 99 ± 19.6 minutes). The median length of follow-up after surgery was 24 months (mean 21.8 ± 6.0 months). All patients had improved pain relief and therapeutic coverage with no complications. CONCLUSIONS: Paddle-to-percutaneous SCS surgery is a feasible and durable revision option in appropriately selected patients.

Spinal Cord Stimulator Paddle Lead Revision and Replacement for Misplaced or Displaced Electrodes.

OBJECTIVE: Spinal cord stimulators (SCSs) are commonly implanted via a laminotomy or laminectomy. Revision surgery may be necessary in instances of hardware failure or loss of efficacy. It is uncommon for leads to have been initially misplaced in a suboptimal position and revision in these cases necessitates additional dissection for appropriate repositioning. Accordingly, there is concern with a more extensive revision for a potentially higher risk of associated complications. This study aims to describe a series of patients with failed paddle SCS electrodes due to misplacement who underwent revision and replacement. METHODS: Patients who underwent SCS paddle replacement for misplaced paddles between 2021 and 2023 were identified. Medical charts were reviewed for demographic data, operative details, and incidence of complications. RESULTS: Sixteen patients underwent thoracic SCS paddle revision and replacement. The mean age was 59.6 ± 12.6 years, with 11 females and 5 males. Misplaced paddles were too lateral (n = 12), too high (n = 2), or incompletely within the epidural space (n = 2). The mean duration from initial implantation to revision surgery was 44.8 ± 47.5 months. The mean operative duration was 126.1 ± 26.9 minutes and all patients required a "skip" laminectomy or laminotomy. No complications were encountered. The mean length of follow-up was 18.4 ± 7.3 months. Mean preoperative pain intensity was 7.9 ± 1.5 and at last follow-up was 3.6 ± 1.7 (P < 0.001). All but 1 patient continued to use their device in follow-up. CONCLUSIONS: The revision and replacement of misplaced paddle SCS electrodes is a feasible and durable revision strategy, even in long-term implants with extensive scarring.

Status Epilepticus and Low-Grade Glioma in the Pregnant State: Case Report and Ethical Considerations.

Introduction: The pregnant state may cause or exacerbate existing neurological disease. Gliomas appear to be influenced by the physiological changes that occur during pregnancy. The pregnant state may also cause seizures, including status epilepticus. There are currently no defined treatment guidelines to direct clinical decision making, and many of the commonly employed therapies are contraindicated during pregnancy. Case Presentation: The current article describes the case of a 40-year-old G3P1101 female at 10 weeks' gestation, who sought medical care for recurrent left hemifacial twitching, eventually leading to nonconvulsive status epilepticus. Intubation and sedation were required to achieve seizure cessation. Imaging revealed a lobulated cystic mass in the right parietal lobe, suspicious for low-grade glioma. Despite thorough explanation of the potential risks, the patient adamantly wished to pursue surgical intervention. An uneventful craniotomy was performed for resection of a low-grade glioma. No patient or fetal complications were encountered, and the patient has not had any reported seizures since surgery. Discussion: Managing complex neurosurgical diseases in pregnant patients provides both clinical and ethical quandaries. We describe the successful management of a patient presenting with status epilepticus caused by an underlying glioma during pregnancy. Although challenging, favorable neurosurgical outcomes are possible during pregnancy.