Objective: To compare the conventional “Twist & Anti-Twist” technique and “Spiral Tunnelling Technique”(STT) for tunnelling the leads for Deep Brain Stimulation surgery in PD.

Background: Tunnelling the leads from subgaleal location to subclavicular pouch during DBS surgery can be difficult sometimes, especially getting over the nuchal fascia. Various problems can be encountered like a) injury to underlying venous channels and torrential hemorrhage, b) tunnel track hematomas and ecchymosis, c) pneumothorax, d) cutaneous perforation while tunnelling. We describe a new technique(STT) in comparison to the conventional one to avoid these complications.

Method: THE natural movement of any surgeon for tunnelling is a “TWIST&ANTI-TWIST” motion with continuous forward pressure. STT involves applying constant forward pressure in a screwing pattern in a  continuous downward spiral(No anti-twist). We divided our groups into two – A)Conventional ,B) STT. 20 subjects(sex and BMI matched) were included in each group and following parameters analysed -1)time taken for tunnelling ,2) difficulty faced in getting over the nuchal fascia, 3)complications if any.

Results: Time taken for tunnelling (Mean) : 4’36”±54”(SD) in group A(Range 2’30” to 6’10”) and 1’38”±30”(SD) in group B(Range 45” to 2’10”). Difficulty faced by surgeon : 5 cases of difficulty were encountered in group A and none in group B. Complications : 2 in group A(1 excessive tunnel track bleeding and  skin ecchymosis, 1 cutaneous perforation while tunneling) and no complications in group B.

Conclusion: This spiral technique creates more torque when a resistance is encountered at the nuchal fascia and thus easily breaks the fascia with minimal effort and helps surpassing the obstacle while tunnelling. This technique can be performed easily, is reproducible, consumes less time and the surgeon has more control and less chances of encountering tunnelling related complications.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/spiral-tunneling-technique-for-passing-electrode-lead-for-deep-brain-stimulationdbs-surgery-in-parkinsons-diseasepd/