WCTN: World Collaborative Textbook of Neurosurgery

While the most common targets are the S2 foramina for disorders requiring unilateral or bilateral S2,3,4 neuromodulation, there are several clinical situations where other targets are desirable that are best reached with a similar use of the “laterograde” approach.

For difficult to capture neuropathic foot pain, a retrograde placement in the midline to  L3/4 and then rotated to the L4 foramen (Figure 12).  This places the electrode such that an anode at the foramen with the remaining three contacts as cathode provides stimulation of the L4, L5, and S1 dorsal roots.

Coccygodynia is best treated with implantation over the S4 and 5 roots and stimulation of the lower sacral and coccygeal roots (Figure 13).  The percutaneous quadripolar electrode is placed with the standard “laterograde” entry and advanced caudally in the midline until it reaches S3.  Do not deflect laterally toward a foramen, but leave the electrode midline caudally.  Avoid placing the tip close to the sacral hiatus as undesired stimulation may result in pain. The electrode is again programmed with the distal contact as anode and proximal contacts as cathodes.

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Created by Max Gosey on 2010/06/11 06:08
     

Chapter List

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*New Table of Contents\

-VOLUME I: NEUROLOGY\

-*VOLUME II: GENERAL NEUROSURGERY SPACE HAS BEEN CREATED\

-VOLUME III: STEREOTACTIC AND FUNCTIONAL NEUROSURGERY yes\

-VOLUME IV: PAIN yes\

-VOLUME V: SURGERY FOR EPILEPSY SPACE HAS BEEN CREATED (but don't try to create pages, as we don't have any content to put into them yet)\

-VOLUME VI: ENDOVASCULAR NEUROSURGERY\

-VOLUME VII: NEUROLOGICAL ONCOLOGY yes\ .\ .\ -\ -\ _.\ .\ .\ .\ .\ .\ .\ .\ .\ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

-VOLUME I: FUNCTIONAL NEUROSURGERY

Chapter 9

-Chapter 10

-Chapter 11

-Chapter 12

-Chapter 13

-Chapter 14: Thalamic Ventral Intermediate Nucleus Stimulation for Essential Tremor

-VOLUME II: NEUROONCOLOGY

-Chapter 15: Histological Types of Tumors

-Chapter 16: Metastasis

-Chapter 17: Posterior Fossa Tumors

-Chapter 18: Meningiomas

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VOLUME III: GENERAL NEUROSURGERYChapter 32

-Chapter 33

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