Concurrent Placement of Bilateral Suboccipital and Supraorbital Nerve Stimulators Using On-Q* Tunneler: Technical Note.

BACKGROUND: Stimulation of the occipital and supraorbital nerves is used to treat chronic migraine refractory to medical management. Placement of cranial leads is often challenging due to the rigid Touhy needle included in the kit for its placement.

OBJECTIVE: To report the first case of concurrent placement of bilateral supraorbital (SNS) and occipital nerve stimulators (ONS) from a unilateral approach using the On-Q* Tunneler, (Halyard Health, Alpharetta, Georgia) a flexible, blunt tipped plastic tunneler with a tear-away sheath.

METHODS: We present the case of a 49-yr-old female with debilitating daily holocephalic headaches who underwent placement of SNS and ONS through a cervical and left temporal incision at an outside hospital. She presented to our institution with purulent drainage from the temporal incision and the system was removed. We describe an alternative approach to bilateral SNS and ONS placement with a soft flexible tunneling device, which facilitated placement of the entire system through a right temporal incision, thereby avoiding her previously infected surgical sites.

RESULTS: The patient reported complete resolution of her daily headaches and was able to resume her activities as a full-time student.

CONCLUSION: The flexibility of the On-Q tunneler device (Halyard Health) allows the placement of bilateral SNS and ONS from a unilateral incision, thereby minimizing the cosmetic effect and infectious risk of this procedure.