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Occipital Nerve Stimulation Periprocedural Care

  • Author: Antonios Mammis, MD; Chief Editor: Jonathan P Miller, MD  more...
 
Updated: Oct 14, 2015
 

Patient Education & Consent

Elements of Informed Consent

Occipital nerve stimulation (ONS) for headache and craniofacial pain is not FDA-approved and thus represents an off-label use of this technology. Insurance companies may or may not cover the cost of occipital nerve stimulation placement, and patients are encouraged to contact their insurances to see if they qualify as candidates and if insurance will cover it.

Patients who are interested in participating in one of several clinical trials are referred to ClinicalTrials.gov.

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Pre-Procedure Planning

Prior to implantation, a trial is performed in which leads are placed under the skin and are connected to an external battery. The trial is performed under sedation, and the patient is discharged the same day. Afterward, the patient tries the therapy for 4-7 days and keeps a detailed pain diary.

A permanent device is implanted only if the patient reports significant improvements in pain and quality of life.

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Equipment

Occipital nerve stimulation involves an implantable device composed of an electrode and pulse generator.

Image 1. A fluoroscopic images of occipital leads Image 1. A fluoroscopic images of occipital leads in the supraorbital (A), infraorbital (B), and occipital (C) region in a patient with intractable cluster headache
Image 2. A fluoroscopic images of occipital leads Image 2. A fluoroscopic images of occipital leads showing stacked left-sided occipital leads in a woman with hemicrania continua.
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Patient Preparation

Anesthesia

Local anesthesia is used at the incision site only.

Positioning

The patient may be positioned laterally or prone depending on the incision entry point.

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Monitoring & Follow-up

The device is programmed by a clinical specialist, appointed by the manufacturer.

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Device Programming and Maintenance

Most patients currently opt for the implantable pulse generator system, which is currently an off-label application for peripheral use. The life of the battery varies depending on the amplitude used and the number of hours the device is left on during the day. With the voltage settings usually required for occipital stimulation, the primary cell lithium ion battery can last 3-5 years, while the rechargeable may last 7-9 years before replacement.

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Contributor Information and Disclosures
Author

Antonios Mammis, MD Assistant Professor of Neurological Surgery, Director, Functional and Restorative Neurosurgery, Director, Center for Neuromodulation, Director, Rutgers Center for Headache, Orofacial, and Neuropathic Pain, Rutgers New Jersey Medical School

Antonios Mammis, MD is a member of the following medical societies: American Academy of Pain Medicine, American Association of Neurological Surgeons, American Medical Association, Medical Society of the State of New York, World Society for Stereotactic and Functional Neurosurgery, Congress of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery

Disclosure: Nothing to disclose.

Coauthor(s)

Gaurav Gupta, MD Director, Cerebrovascular and Endovascular Neurosurgery, Assistant Professor, Division of Neurological Surgery, Rutgers Robert Wood Johnson Medical School

Gaurav Gupta, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Ahmed Meleis, MD Resident Physician, Department of Neurosurgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Disclosure: Nothing to disclose.

Chief Editor

Jonathan P Miller, MD Director, Functional and Restorative Neurosurgery Center, Associate Professor of Neurological Surgery, George R and Constance P Lincoln Endowed Chair, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine

Jonathan P Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Medical Association, Congress of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery, North American Neuromodulation Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic Neuromodulation.

References
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Image 1. A fluoroscopic images of occipital leads in the supraorbital (A), infraorbital (B), and occipital (C) region in a patient with intractable cluster headache
Image 2. A fluoroscopic images of occipital leads showing stacked left-sided occipital leads in a woman with hemicrania continua.
A schematic diagram of the gate control theory of pain.
 
 
 
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