Model 37022

A detailed description of the PNS procedure has been described by Lerman et al. (2015) (link). Briefly, patients were placed supine with the head turned to the contralateral side of the surgical approach. Local anesthesia was induced with 1% lidocaine in a total volume of 10 mL by infiltration 2 cm lateral to the orbit at the level of the supraorbital ridge and superficial temporal fascia. A 14-G Tuohy needle was inserted 2 cm posterolateral to the junction of the frontal and zygomatic portion of the orbital rim. The Tuohy needle was advanced through the tissue and aimed at a supra-periosteal tissue plane over the eyebrow in a semilunar path, cephalad to the orbicularis oculi, terminating slightly in the cranial midline. A test stimulation lead with eight electrodes (Model 3873; Medtronic, Minneapolis, MN, United States) was inserted through the Tuohy needle. Fluoroscopic imaging was used to identify the eight-contact lead overlying the supraorbital ridge (Figure 1), and the guiding needle was removed after the lead had been placed in the desired location. The distal ends of the inserted electrodes were connected to an extension multi-lead cable (Model: 355531; Medtronic). To program the implantable electrodes, the external cable was plugged into a neurostimulator (Model 37022; Medtronic).

Details of the surgical procedure have been described by Lerman et al. (2015) (link) previously. Specifically, the head of the patient was turned contralateral to the surgical site in a supine position. Local anesthesia was administered with 1% lidocaine infiltrating 2 cm lateral to the orbit at the level of the supraorbital ridge and superficial temporal fascia. One Tuohy needle (14G) was applied to guide electrode implantation. The entry point was approximately 2 cm posterolateral to the junction of the frontal and zygomatic portions of the orbital rim. The guiding needle was advanced above the eyebrow along a semilunar path, cephalad to the orbicularis oculi, terminating slightly beyond the cranial midline. An eight-contact stimulation lead (model 3873; Medtronic, Minneapolis, MN, United States) was inserted through the Tuohy needle, overlying the supraorbital ridge as identified by fluoroscopic imaging (Figure 1A). The distal end of the lead was then connected to an extension multi-lead cable (Model: 355531; Medtronic, Minneapolis, MN, United States). To program the PNS, the external cable was plugged into a neurostimulator (Model 37022; Medtronic, Minneapolis, MN, United States).