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Surgical Tools For Peripheral Nerve Stimulation
Peripheral Nerve Stimulator Configurations
Peripheral nerves can be nonspecifically and specifically targeted for neuromodulation via a variety of configurations. These range from transcutaneous stimulation to partially implanted systems, to fully implanted electrode/receivers with external generators, to fully implanted electrodes and generators ( Fig. 5.1 ). In general, the more invasive approaches are more durable and require a procedure suite with the option for anesthesia, surgical antisepsis, sterile instrumentation, and skilled perioperative personnel. The existence of various peripheral nerve stimulation (PNS) configurations provides the clinician with an expanded toolbox to tailor therapy to patient anatomy, required duration of therapy, and chronicity of disease. Prior to the availability of purpose-built equipment for PNS, spinal cord stimulator equipment was typically repurposed for use in PNS. Modern PNS is typically performed with image guidance; depending on the target, this may include ultrasound, fluoroscopy, or other modalities (see Chapter 4 ). This chapter will focus on the surgical tools required for the current system configurations that are approved by the US Food and Drug Administration for PNS.
Peripheral Nerve Stimulation Surgical Implantation
PNS configurations requiring the implantation of permanent electrodes with subcutaneous receivers or generators are considered surgical implants. It behooves the neuromodulator to have a working knowledge of appropriate presurgical work-up, including adherence to local and national best practices for perioperative infectious and risk mitigation strategies, prior to entering the surgical episode of care. The best surgical tools that the implanter has are his or her judgment, knowledge, and the adoption of best practices and refinement of one’s own technique through the process of lifelong learning.
General instruments
Surgical instruments are typically available as individual sterile instruments or as “sets,” and it behooves the implanter to familiarize himself or herself with the available instruments and sets available in their institution. In general, the types of instruments required for PNS implantation are as follows:
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