Acute hyperactive delirium-like episode during dexmedetomidine sedation after recent discontinuation of long-term reserpine therapy: a case report.

Sacral neuromodulation (SNM) has emerged as an effective minimally invasive therapy for refractory lower urinary tract dysfunction (LUTD) via electrical stimulation of the S2–S4 sacral nerve roots []. The procedure is typically performed in two stages, wherein the precision of Stage I electrode implantation represents a critical determinant of therapeutic success. Suboptimal lead placement compromises the number of effective contacts, increases stimulation thresholds, and reduces implantable pulse generator longevity [, ]. However, conventional fluoroscopy-guided puncture relies heavily on bony landmarks and surgeon experience, often proving inadequate in patients with sacral anatomical variations, obesity, or intraoperative positional changes. This “blind” approach frequently necessitates repeated needle adjustments, prolonging operative time and exposing both patients and medical staff to substantial ionizing radiation [, ]. To overcome these limitations, various auxiliary navigation techniques have been explored. Computed tomography (CT) guidance provides superior anatomical resolution yet entails significant radiation exposure []; ultrasound offers real-time imaging but is constrained by poor penetration through bone cortex []; while three-dimensional (3D) printing navigation templates and augmented reality (AR) navigation, despite their potential, remain limited by high costs, complex preoperative preparation, and inability to adapt dynamically to soft tissue deformation [, ]. Hence, the search for an auxiliary technique capable of high-precision real-time guidance while minimizing radiation exposure remains a research priority in the field of SNM. Optical navigation system (ONS) represents a promising alternative that integrates multimodal image fusion (combining CT bony structures with MRI soft-tissue details) with infrared optical tracking to provide real-time, submillimeter-level three-dimensional visualization []. This technology has demonstrated reliability in percutaneous nephrolithotomy [] and orthopedic spine surgery [], yet its application in SNM has been limited to in vitro phantom studies [], with no prospective clinical validation conducted to date. Therefore, we conducted this prospective randomized controlled trial to investigate the clinical value of ONS combined with multimodal image fusion in SNM electrode implantation, hypothesizing that this technique would improve implantation precision, reduce radiation exposure, and enhance Stage II conversion rates compared with conventional fluoroscopic guidance.