Real Time Navigation Assisted Sacral Neuromodulation: A New Technique for Lead implantation

Onem K1, Kuruoglu E2, Baydin S3, Gurgun A4, Resorlu B1, Tilki H5

Research Type

Clinical

Abstract Category

Neurourology

Abstract 585
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Scientific Open Discussion Video Session 38
On-Demand
Neuromodulation Surgery New Instrumentation
1. Ondokuz Mayis University, Medical Faculty, Department of Urology, Samsun, Turkey, 2. Medicana Hospital, Department of Neurosurgery ,Samsun,Turkey, 3. Ondokuz Mayis University, Medical Faculty, Department of Neurosurgery, Samsun,Turkey, 4. KJF Sankt Elizabeth Klinikum Gynäkologie/Geburshilfe, Neuburg an der Donau /Deutschland, 5. Ondokuz Mayis University, Medical Faculty, Department of Neurology, Samsun, Turkey
Presenter
K

Kadir Onem
Links

Abstract

Introduction 
The aim of this study to define navigation assisted a new technique of lead implantation for sacral neuromodulation.
Design 
Twenty-five years old male patient with non obstructive urinary retention underwent sacral neuromodulation(SNM). Preoperative computerized tomography on prone position was used for navigation system (Brainlab AGFeldkirchen,Germany). Under general anesthesia patients’ position changes supine to prone. Patient was stabilized with adhesive tapes to operation table. Reference tool attached to operation table and stabilized. Pointer was touched to patient’s skin on reference points in order to registration(Brainlab system do spatial positioning to patient). Adaptor tool attached to foramen needle and needle was introduced to navigation system(Figure I). After reversing of neuromuscular blockage, needle was inserting with assisted real time 3D navigation on bone pelvis(Figure II) . Trajectory of navigation system can help to targeting of s3 foramen. After insertion of needle to s3 foramen needle was stimulated in order to get motor response. After than all of procedure continue as a standard with using floroscopy.
Results 
In this new method we I inserted the needle s3 foramen at the first attempt.
Conclusion 
Navigation assisted sacral neuromodulation can facilitate the procedure and guaranteed our needle positioning on foramen which we targeted with the 1-2 mm of error. Same system can be used on pudendal neuromodulation as well. This method can be used especially sacral bone abnormalities and physicians who still training on SNM.
Figure 1 Patients position, reference tool, adaptor tool attached to foramen needle
Figure 2 Foraminal puncture. On Navi system + sign was seen at s3 foramen. + sign is tip of foramen needle.
Disclosures
Funding no Clinical Trial No Subjects None
17/05/2024 05:16:32