Occipital nerve stimulator systems: review of complications and surgical techniques

Introduction: Stimulation of the occipital nerves is becoming more widely accepted in the treatment of occipital neuritis and migraine disorders. Objective: Presently, equipment available for spinal cord stimulation is adapted for insertion into the subcutaneous space over the occipital nerves. Many technical factors need to be reassessed to optimize the therapy. Methods: We performed a retrospective review of patients implanted from 2003 to 2007 at a single center. We aimed to analyze the rate of surgical complications related to implantation technique. A total of 28 patients were present for analysis. Patients were followed up to 60 months with a mean follow-up of 21 months. Results: There is a 32% revision rate for electrode migration or displacement, 3.6% removal rate for infection, and a 21% removal rate for lack of efficacy. Although not well studied secondary to small patient populations, this was consistent with a review of the literature which demonstrated a 10-60% revision rate. Other factors such as anchoring strategy, strain relief, and battery location were all considered in the analysis and will be presented. A major determination was that use of a second incision with an additional strain relief loop had only a 10% revision rate of the lead while those without this additional strain relief loop had a 62.5% revision rate. Conclusion: Many technical factors need to be addressed for optimization of occipital nerve stimulation.