Fluoroscopy-Guided Electrode Placement for Porcine Sacral Neuromodulation Studies.

Area of Science:

• Biomedical Engineering
• Neuroscience
• Surgical Techniques

Background:

• Sacral neuromodulation is a key treatment for bladder dysfunction and pelvic pain.
• Porcine models are valuable for neuromodulation research due to anatomical similarities.
• Current methods for electrode placement in pigs lack precision.

Purpose of the Study:

• To develop and validate a fluoroscopy-guided protocol for accurate sacral nerve electrode implantation in pigs.
• To overcome limitations of "blind" electrode targeting.
• To establish a reliable method for porcine sacral nerve stimulation.

Main Methods:

• Detailed anatomical dissection and microCT characterization of porcine sacral nerves.
• Assessment of needle trajectories through S1, S2, and S3 sacral foramina using fluoroscopy.
• Development and in vivo testing of a step-by-step implantation protocol in Yucatan minipigs.
• Confirmation of nerve activation via bladder and external anal sphincter response.

Main Results:

• Identified optimal electrode placement through S2 and S3 foramina, deeming S1 infeasible.
• Established specific fluoroscopic landmarks for precise targeting.
• Demonstrated successful in vivo activation of target nerves through percutaneous electrode placement.
• Achieved accurate and precise electrode placement using minimally invasive techniques.

Conclusions:

• A validated fluoroscopy-guided protocol enables precise electrode placement on porcine S2-S3 sacral nerves.
• This standardized method enhances the reliability of porcine models for neuromodulation research.
• The technique facilitates consistent activation of sacral nerves, crucial for developing new therapies.