Cervical epidural abscess due to implantation of a spinal cord stimulation lead.

Spinal cord stimulation (SCS) for intractable pain syndromes has become a pillar of modern pain management. Common complications include lead migration, implant infection, cerebral spinal fluid leak, and lead fracture. Spinal epidural abscess due to spinal cord stimulator implantation is a very rare occurrence with only two cases reported in the literature so far. We present an illustrative case and discuss the pathophysiology and best clinical management for this very rate entity.

Endoscopic Lateral Approach for Dorsal Root Ganglion Burst Stimulation: Technical Note and Illustrative Case Series.

INTRODUCTION: Dorsal root ganglion (DRG) stimulation demonstrated superiority over traditional spinal cord stimulation with better pain relief and greater improvement of quality of life. However, leads specifically designed for DRG stimulation are difficult to implant in patients who previously underwent spinal surgery and show epidural scarring at the desired site of implantation because of the reduced stiffness of the lead. Nevertheless, recurrent leg or arm pain after spinal surgery usually manifests as a single level radiculopathy, which should theoretically be amenable to DRG stimulation. MATERIALS AND METHODS: We present the percutaneous transforaminal placement of cylindrical leads through a lateral endoscopic approach for DRG stimulation in burst mode. RESULTS: We could successfully show that percutaneous transforaminal lead placement is feasible in three illustrative cases. CONCLUSION: This technical note combines two innovations, one linked to the other. The first innovation involves a novel endoscopic lateral transforaminal approach to insert a cylindrical lead to the DRG. Because this electrode is compatible with burst stimulation-enabled devices, a second innovation consists of the application of burst stimulation on the DRG.

Placement of Surgical Spinal Cord Stimulation Leads Using Spinal Process Splitting Laminotomy: Technical Note.

OBJECTIVE: Spinal cord stimulation has become an established method within the therapy of chronic pain allowing for significant pain relief. Surgical leads usually must be implanted via a surgical procedure involving unilateral or bilateral muscle detachment and partial laminectomy. METHODS: We present the application of a novel minimal invasive microsurgical approach for lead placement, which combines the beneficial advantages of anatomic midline lead placement while preserving the midline structures, avoiding muscle detachments, and thus ensuring spinal stability: spinal process splitting laminotomy. CONCLUSIONS: The spinal process splitting laminotomy technique can be successfully applied to introduce the surgical leads for spinal cord stimulation.

Skull base approaches in neurosurgery.

The skull base surgery is one of the most demanding surgeries. There are different structures that can be injured easily, by operating in the skull base. It is very important for the neurosurgeon to choose the right approach in order to reach the lesion without harming the other intact structures. Due to the pioneering work of Cushing, Hirsch, Yasargil, Krause, Dandy and other dedicated neurosurgeons, it is possible to address the tumor and other lesions in the anterior, the mid-line and the posterior cranial base. With the transsphenoidal, the frontolateral, the pterional and the lateral suboccipital approach nearly every region of the skull base is exposable.In the current state many different skull base approaches are described for various neurosurgical diseases during the last 20 years. The selection of an approach may differ from country to country, e.g., in the United States orbitozygomaticotomy for special lesions of the anterior skull base or petrosectomy for clivus meningiomas, are found more frequently than in Europe.The reason for writing the review was the question: Are there keyhole approaches with which someone can deal with a vast variety of lesions in the neurosurgical field?In my opinion the different surgical approaches mentioned above cover almost 95% of all skull base tumors and lesions. In the following text these approaches will be described.These approaches are:1) pterional approach2) frontolateral approach3) transsphenoidal approach4) suboccipital lateral approachThese approaches can be extended and combined with each other. In the following we want to enhance this philosophy.