![]() ![]() System impedance is tested to assure that all connections are intact prior to irrigation with antibiotic solution and closure.ĭarrel F. Keeping track of the separate left- and right-sided leads will help to ensure consistency. ![]() Both extension wires are then inserted into the pulse generator and secured in place by tightening set screws. A Silastic sleeve is slid on to this connection site and secured in place using nonabsorbable suture. The lead is then inserted into the extension wire and secured in place by tightening set screws. The plastic plugs from the distal end of the leads are removed and the leads cleansed. Using a tunneling device, the extension wires are passed from the infraclavicular incision to the posterior auricular incision and then to the cranial incision. A small incision is then made in the posterior auricular region and the cranial incisions are reopened, as well exposing the distal ends of the leads. Using a combination of bipolar cautery and sharp dissection, a pocket is made above the pectoralis fascia. A 5–6-cm horizontal incision is made 2–3 cm below the clavicle. The patient is positioned supine with the head turned the contralateral direction. The IPG is commonly placed inferior to the clavicle superficial to the pectoralis fascia. The procedure is done under general anesthesia as an outpatient. The implantable pulse generator (IPG) and extension wires may be implanted either contemporaneously with the DBS leads, or at a separate procedure usually performed 5–14 days following lead implantation. Henderson, in Handbook of Clinical Neurology, 2013 Pulse generator placement ![]()
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