ImplantTechnique翻译-课件.pptVIP

* Scheduling can be more difficult with tunneled since it is a staged procedure. Incision is invasive. Easier to sell a percutaneous trial than an incision and two trips to the OR. If the trial did not work then the patient underwent additional risk of complications and another incision. Can’t use monopolar electrocautery around the introducer needle. Infection risk is theoretically higher. Percutaneous trial then implant is more time consuming since have to place leads twice. Trial helps to determine optimal lead placement. Sometimes fooled since patient is in the prone position during placement. With supine the stimulation may change. * ? Some physicians prefer a totally implanted technique, with the lead remaining implanted after successful test stimulation. This approach can be undertaken when the same percutaneous lead is used for implant. ? During the test stimulation procedure, the surgeon cuts down to the level of the supraspinous ligament and anchors the lead to prevent its movement after surgery. ? The surgeon reconnects the screening cable to the lead and retesst the patient to ensure that the lead has not moved during the anchoring process. Then a percutaneous extension is externalized for the trial screening period. 植入C3平面 * Stim Set 1 双足覆盖 Stim Set 2 覆盖左下肢 Stim Set 3 覆盖右下肢后背 Stim Sets 多 电极广覆盖 术中筛选 1、手术安排：对于植入测试需两次手术时间 2、另外的切口，假如植入式测试失败 3、植入测试更痛。会影响患者的活动或者需要更多的阵痛药物。经皮测试相反。 4、植入式的感染风险相对较高 5、植入式的总测试及植入时间相对较短，但假如测试失败，植入式需更多时间。 6.假如电极放置不顺利，经皮测试相对于植入测试会比较繁琐，在这方面，植入式比较推荐。 7、植入式测试比较难调整电极位置，更消耗时间。因为测试需要调整覆盖的位置。 Source: Cameron T Journal of Neurosurgery 2004 电极偏移 导丝置于棘上韧带 反复测试患者 外部接口 * * The following slides cover the procedure used to implant a neurostimulation system. * The following slides cover the procedure used to implant a neurostimulation system. * The following slides cover the procedure used to implant a neurostimulation system. * ? Begin the test stimulation procedure by placing the patient in a prone position with a pillow under his or he