A Simple Scalp Tunneling Technique Using a Foldable Tunneling Tool for Placement of Deep Brain Stimulation Electrode Lead

Abstract In bilateral deep brain stimulation (DBS) with a dual-channel implantable pulse generator (IPG), creating a subgaleal tunnel for the contralateral lead is challenging because existing tunneling devices are either too short or too rigid. Hardware complications, such as infection and erosion, remain among the most common sources of morbidity. We describe a simple and minimal technique using a sterile intubation guide and the straw included with the Boston Scientific tunneling tool. We developed a tunneling technique that repurposes a sterile 14-Fr intubation stylet from a Boston Scientific tunneling kit, placed inside a plastic straw. The stylet provides both flexibility and stiffness to navigate the skull's curvature, while lubrication ensures smooth passage. After tunneling, the stylet is removed, and the DBS lead is threaded through the straw, which is then withdrawn. From 2020 to 2025, we applied this technique in 17 bilateral DBS cases (mean age 60.7 years). No additional scalp incisions were necessary. We observed no infections, erosions, or scalp injuries related to the technique, and only one case of hardware malfunction; no other complications were reported. This pragmatic approach appears to provide a minimally traumatic method for subgaleal midline tunneling in bilateral DBS. By avoiding auxiliary incisions and potentially reducing mechanical stress on the lead, it may help decrease device-related morbidity.