Sacral nerve stimulation lead implantation in partial sacral agenesis using intra-operative computerized tomography

Area of Science:

• Neurology
• Surgical Innovation
• Medical Imaging

Background:

• Sacral nerve stimulation (SNS) is a treatment for fecal incontinence.
• Accurate lead placement is crucial for SNS efficacy.
• Sacral anomalies can complicate lead implantation due to absent anatomical landmarks.

Observation:

• A novel percutaneous nerve evaluation for SNS was performed in a patient with fecal incontinence due to congenital imperforate anus and partial sacral agenesis.
• The procedure utilized an intra-operative O-arm imaging system and neurophysiological monitoring.
• Neuronavigation guided the identification of the skin insertion point and lead trajectory.

Findings:

• The O-arm system and neuronavigation allowed precise identification of the S3 foramen.
• The SNS lead was successfully inserted into the right S3 foramen at the correct depth.
• Neurophysiological control confirmed accurate stimulation of the right S3 nerve root, eliciting an appropriate motor response.

Implications:

• O-arm guided navigation offers a viable solution for overcoming challenges in SNS lead placement in patients with sacral anomalies.
• This technique enhances the feasibility of SNS for fecal incontinence in complex anatomical cases.
• Intra-operative imaging and neurophysiological control improve the safety and accuracy of sacral lead implantation.