(12) Comparative Evaluation of Percutaneous Techniques for Accessing the Distal-Hypoglossal Nerve for Minimally-Invasive Bilateral-Hypoglossal Nerve Stimulation

Introduction: Hypoglossal nerve stimulation (HNS) is a growing therapy for OSA treatment, and currently approved therapies require surgical dissection of hypoglossal nerve (HGN) branches. This study compares two percutaneous techniques to access the distal HGN branches to the genioglossus muscle. We identify the most effective approach for placement of a wide-field (>4 mm), directional, and multi-contact lead for bilateral HNS.

Methods: Six human cadaver heads were used to evaluate two bilateral percutaneous techniques: Technique A, anterolateral, and Technique B, paracoronal. Each technique was performed by three surgeons for accuracy of nerve targeting, procedural time, number of attempts, and ease of wide-field lead deployment. Ultrasonographic guidance was employed to avoid the submandibular gland. Post-procedural ultrasound and dissections confirmed wide-field placement across the HGN.

Results: Results showed both techniques accessed the distal HGN successfully in all cadaver heads. Technique A had a mean HGN procedural access time of 10 minutes, while Technique B averaged 5 minutes. Technique A had lower nerve targeting accuracy, with less electrode coverage compared to Technique B, 4mm within target vs 2 mm, respectively. Each surgeon made 2 attempts on each technique. Dissections confirmed correct orientation and proximity.

Conclusion: This study highlights that the HGN is repeatably accessible percutaneously using ultrasound guidance, provided that a wide-field electrode is employed. Both access techniques facilitated lead deployment at the distal HGN segment, but Technique B was preferred by all three surgeons subjectively for reduced procedural time and positioning accuracy. Future research should involve in-vivo studies to validate these findings and measure clinical outcomes.