Internet Neurovascular Rounds

Case 1 History
Presented by: Dr. Kris Kumar Neurosurgeon, Regina

Age: 68
Sex: Male
History:
1974 - L_4-5 right disc - No relief

1976 - Repeat L_4-5 right disc- No relief

1986 - Laminectomy - No relief

1988 - Severe back pain and right leg pain. Stopped working. Forward flexion up to knee level, straight leg raising right 45, left 75. Right ankle jerk absent.

1990 - CT scanning shows scarring and arachnoiditis
Double blind morphine naloxone test - positive.
OR - Deep brain implant in left PVG - Good pain control.

1994 - Gradual reduction in pain benefit. Developed tolerance.

1995 - Left DBS cut flush with burr hole and a new electrode implanted in the right PVG. Good resumption of pain control which has continued until today.

November, 2000 - The electrode connector of the right PVG has efoded through the scalp in the last two weeks.

Questions

What to do for the pain relief as the presently functioning right PVG electrode will have to be removed?
Should we implant a new electrode on the left side where tolerance had developed in the past?
Should he be switched to a synchromed pump?

X-Rays

X-ray of head showing implants.

November 2000 images

Images of the electrode connector of the right PVG eroded through the scalp.

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