Percutaneous occipital stimulator lead tip erosion: report of 2 cases

Occipital nerve stimulation is an emerging treatment modality for refractory headache disorders like migraine and cluster headache. Either percutaneous or surgical leads are implanted subcutaneously in the occipital region in an effort to stimulate the distal branches of the occipital nerves (C2-3). A number of complications of this technique have been reported, such as painful direct muscle stimulation and lead migration. We report the first 2 cases of occipital lead erosion. In both cases, the lead erosion occurred many months after implantation. One patient lost a significant amount of weight between the time of implant and lead erosion, while the other patient had no obvious risk factors. One patient underwent lead removal with reimplantation 1 month later; the other was managed with excision of a granuloma at the erosion site and prophylactic antibiotics. Both patients returned to excellent headache control. Lead erosion is a possible complication of occipital stimulation; strategies to reduce the risk of lead erosion are discussed, although further studies are needed to clarify the best surgical techniques.