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

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

Zion Zibly, Mayur Sharma, Andrew Shaw, Esmiralda Yeremeyeva, Milind Deogaonkar, Ali Rezai 
 Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA

Correspondence Address:
Milind Deogaonkar
Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, Ohio
USA




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;62:703-704


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 2020 Aug 3 ];62:703-704
Available from: http://www.neurologyindia.com/text.asp?2014/62/6/703/149441


Full Text

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}

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}{Figure 3}{Figure 4}

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}

References

1Alex 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.
2Chan 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.
3Ray CD. Burr-hole ring-cap and electrode anchoring device. Technical note. J Neurosurg 1981;55:1004-6.
4Sharma 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.