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Table of Contents    
LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 6  |  Page : 703-704

Deep brain stimulation (DBS), lead migration, and the stimloc cap: Complication avoidance


Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA

Date of Submission11-Jul-2014
Date of Decision09-Dec-2014
Date of Acceptance16-Dec-2014
Date of Web Publication16-Jan-2015

Correspondence Address:
Milind Deogaonkar
Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, Ohio
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.149441

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How to cite this article:
Zibly Z, Sharma M, Shaw A, Yeremeyeva E, Deogaonkar M, Rezai A. Deep brain stimulation (DBS), lead migration, and the stimloc cap: Complication avoidance. Neurol India 2014;62:703-4

How to cite this URL:
Zibly Z, Sharma M, Shaw A, Yeremeyeva E, Deogaonkar M, Rezai A. Deep brain stimulation (DBS), lead migration, and the stimloc cap: Complication avoidance. Neurol India [serial online] 2014 [cited 2019 Sep 22];62:703-4. Available from: http://www.neurologyindia.com/text.asp?2014/62/6/703/149441


Sir,

The reported frequency of migration of the deep brain stimulation (DBS) electrode is about 3.4% and is associated with suboptimal clinical benefits. [1],[2] Medtronic Inc (Minneapolis, MN) has developed a Stimloc burr hole cover system to secure positioning [Figure 1]. [3]
Figure 1: Stimloc system. Blue arrow marking the support clip "pacman". Red arrow marking the skull fixed ring base. Yellow arrow marking the base slot with the lead (adapted with permission from Medtronic Stimloc Technical Manual, Medtronic Inc, Minneapolis, MN, 2007)

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We performed a left Ventralis intermedius nucleus of thalamus (VIM) DBS for essential tremor in a 60-year-old male using Leksell Stereotactic System (Elekta AB, Sweden). [4] Following implantation, lateral fluoroscopy through the Leksell cross hairs targeting system adapter was performed to confirm the position of electrode. The support clip ("pacman") was positioned onto the base ring of the Stimloc system to secure the lead and fluoroscopy repeated. The lead was then carefully released from the robotic drive and no movement of the electrode was confirmed [Figure 2]. The cap was placed and fluoroscopy was repeated [Figure 3]. Before and after cap fluoroscopy images were merged [Figure 4] and lead was noted to have migrated approximately 2 mm dorsal from the target. The cap was removed and the lead was confirmed to revert back to the same starting depth position. The locking slot of the support clip was oriented parallel with the groove in the burr hole base ring. Since the lead wire appeared to angle upwards with placement of the cap, the team suggested a more perpendicular placement of the locking slot of the support clip relative to the groove in the base ring. The support clip was repositioned perpendicular to the groove and fluoroscopy confirmed that the lead was at the original desired depth.
Figure 2: Lateral fluoroscopy was obtained after securing "pacman" support clip confirming the lead is at target

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Figure 3: Lateral fluoroscopy obtained following placement of "Stimloc" cap with subsequent 2 mm depth change

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Figure 4: Merged before and after cap placement fluoroscopy. Placement of the cap caused lateral shift directly below the Stimloc device with subsequent dorsal shift in lead placement (enlarged with contacts highlighted)

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The ideal orientation of the support clip is to position the static side of the V-shaped opening at approximately 90 degrees to the exit slot (Medtronic Stimloc Technical Manual, Medtronic Inc, 2007) [Figure 5]. When the support clip and groove of the base ring are in line, the ideal fulcrum is lost and force can be applied along the lead. Our report describes lead migration and the technical nuances associated with positioning of the Stimloc cap to the burr hole cover during DBS surgery.
Figure 5: (a) Support clip positioned in line with the groove of the base ring. (b) Ideal positioning of the support clip in relation to the base ring

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  References Top

1.
Alex Mohit A, Samii A, Slimp JC, Grady MS, Goodkin R. Mechanical failure of the electrode wire in deep brain stimulation. Parkinsonism Related Disord 2004;10:153-6.  Back to cited text no. 1
    
2.
Chan DT, Zhu XL, Yeung JH, Mok VC, Wong E, Lau C, et al. Complications of deep brain stimulation: A collective review. Asian J Surg 2009;32:258-63.  Back to cited text no. 2
    
3.
Ray CD. Burr-hole ring-cap and electrode anchoring device. Technical note. J Neurosurg 1981;55:1004-6.  Back to cited text no. 3
[PUBMED]    
4.
Sharma M, Rhiew R, Deogaonkar M, Rezai A, Boulis N. Accuracy and precision of targeting using frameless stereotactic system in deep brain stimulator implantation surgery. Neurol India 2014;62:503-9.  Back to cited text no. 4
[PUBMED]  Medknow Journal  


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