Tuesday, April 3, 2012

Revision Surgery - The Rundown

I'm at 3.5 weeks post-op and starting to feel ready to spend time at the computer. The revision surgery went well and thus far my recovery is easier than it was with my last surgery. I'll focus on the surgery in this entry and describe my recovery in another. You can see the incision photos on the Post-Op Pictures tab or by clicking here.

My neurosurgeon was much more thorough than my pain doc who performed the last surgery. First, in our pre-op appointment he had me show him exactly where my pain was. He touched my head to make sure he understood. He consulted with the St. Jude reps present in the appointment & they all came to the consensus that I needed the standard lead placement (a "V" shape over the occipital nerves) but higher up so that it could attend to my temple pain. My prior surgeon didn't even have a pre-op appointment with me, and he never touched my head to get an accurate feel for where my pain was.

Standard "V" shape lead placement

On the day of the surgery, I was put in my own pre-op room in the hospital. My surgeon came in and again asked me to show him exactly where my pain was. Then he used his hands to show me on my head where the leads would be placed. This second confirmation calmed me a lot & eased my worries that it would be a repeat of last time.

Just like in my prior surgery, I was consciously sedated for the lead placement so that I could give feedback when they tested the unit to make sure the leads were stimulating the proper areas. The surgeon first removed the existing leads and then placed the new leads. After the leads were tested and I confirmed they were working properly, I was put all the way under for the remainder of the surgery. The surgeon added a lead anchor which is designed to keep the leads from migrating, a risk that is much higher for ONS than spinal cord stimulation because the leads are so far away from the battery pack. The leads itself were long enough to run directly to the battery, so no wires or connectors were added. There is enough slack in the leads so that I can bend and twist without dislodging the leads. Two incisions were made on my back to facilitate the tunneling of the leads down to the battery pack. A tube is used to feed the leads through, but because my back is so lean, there isn't a lot of stretch to my skin. So, the surgeon made 2 small incisions to add some give. Another incision was added just above the battery pack so that they could plug the leads into the battery.

Example of a lead anchor via St. Jude
When I woke up in recovery, I was immediately administered IV pain medication that helped my pain significantly. My parents and boyfriend came in and told me the surgeon was happy with the results. However, because of the difficulty running the leads down my back, there was trauma to my neck and back and my surgeon anticipated it would be very difficult for me to manage the pain on my own. So, he checked me into the hospital to have the nurses help me manage the pain. He recommended I stay the weekend, but told me to stay as long as I needed to. He mentioned that one patient of his stayed 7 nights.

I was put in my own room on the neurology floor. Upon inspection, I saw that I had a large bandage on my head and 3 on my back (one over the battery and 2 more on my upper back). More of my hair was shaved than last time, but that didn't bother me much because it's worth it to get relief! I was given IV pain meds every 3 hours and had the option to take a breakthrough pain pill every 4 hours. I was administered IV antibiotics twice a day. The nurses were very nice, the hospital food was decent (I could order from a menu), there was a cot for my boyfriend to sleep on, and they had cable and wifi so I was quite comfortable. The downside was that someone was in my room every hour and a half to give me meds or take my vitals, so sleeping was almost impossible. I was able to shower as long as I just washed the front of my body and left my hair alone. I stayed 4 nights but was still hesitant about going home. I was afraid I wouldn't be able to manage my pain. I have a contract with my current pain doctor, so he is the only one that can write prescriptions for narcotics. Prior to the surgery, he added a few pills to my normal, daily pain meds, but I was pretty sure it wouldn't be up to the task to manage my post-surgical pain. My surgeon called my pain doc and explained that my surgery was difficult and that I was in more pain than expected, so a new prescription was added.

The last night I spent in the hospital, a shock came when the neurosurgeon removed the bandage from my head. If you recall from my last surgery, the incisions on my head were only a couple of centimeters long. So imagine my surprise when i saw this! (Scroll down the page to get to the revision surgery photos) I call it my head zipper. There were ~14 stitches on my head. The other 3 incisions were fairly close to the same size as my incisions with my last surgery.

So even with the hospital stay, the experience was so much better than my original permanent implant surgery. I'm very optimistic about my recovery and about the pain-reduction potential of the new lead placement.


  1. I really hope this does the trick for you!

  2. I hope this lead placement works great for you and that you have a speedy recovery!