Histopathologic features of the vagus nerve after electrical stimulation in swine

Quantified Morphology of the Cervical and Subdiaphragmatic Vagus Nerves of Human, Pig, and Rat

It is necessary to understand the morphology of the vagus nerve (VN) to design and deliver effective and selective vagus nerve stimulation (VNS) because nerve morphology influences fiber responses to electrical stimulation. Specifically, nerve diameter (and thus, electrode-fiber distance), fascicle diameter, fascicular organization, and perineurium thickness all significantly affect the responses of nerve fibers to electrical signals delivered through a cuff electrode. We quantified the morphology of cervical and subdiaphragmatic VNs in humans, pigs, and rats: effective nerve diameter, number of fascicles, effective fascicle diameters, proportions of endoneurial, perineurial, and epineurial tissues, and perineurium thickness. The human and pig VNs were comparable sizes (∼2 mm cervically; ∼1.6 mm subdiaphragmatically), while the rat nerves were ten times smaller. The pig nerves had ten times more fascicles-and the fascicles were smaller-than in human nerves (47 vs. 7 fascicles cervically; 38 vs. 5 fascicles subdiaphragmatically). Comparing the cervical to the subdiaphragmatic VNs, the nerves and fascicles were larger at the cervical level for all species and there were more fascicles for pigs. Human morphology generally exhibited greater variability across samples than pigs and rats. A prior study of human somatic nerves indicated that the ratio of perineurium thickness to fascicle diameter was approximately constant across fascicle diameters. However, our data found thicker human and pig VN perineurium than those prior data: the VNs had thicker perineurium for larger fascicles and thicker perineurium normalized by fascicle diameter for smaller fascicles. Understanding these differences in VN morphology between preclinical models and the clinical target, as well as the variability across individuals of a species, is essential for designing suitable cuff electrodes and stimulation parameters and for informing translation of preclinical results to clinical application to advance the therapeutic efficacy of VNS.

On the parameters used in finite element modeling of compound peripheral nerves

OBJECTIVE

Computational modeling is an important tool for developing and optimizing implantable neural stimulation devices, but requires accurate electrical and geometrical parameter values to improve predictive value. We quantified the effects of perineurial (resistive sheath around each fascicle) and endoneurial (within each fascicle) parameter values for modeling peripheral nerve stimulation.

APPROACH

We implemented 3D finite element models of compound peripheral nerves and cuff electrodes to quantify activation and block thresholds of model axons. We also implemented a 2D finite element model of a bundle of axons to estimate the bulk transverse endoneurial resistivity; we compared numerical estimates to an analytical solution.

MAIN RESULTS

Since the perineurium is highly resistive, potentials were approximately constant over the cross section of a fascicle, and the perineurium resistivity, longitudinal endoneurial resistivity, and fascicle diameter had important effects on thresholds. Activation thresholds increased up to ~130% for higher perineurium resistivity (~400 versus 2200 Ω m) and by ~35%-250% for lower longitudinal endoneurial resistivity (3.5 versus 0.75 Ω m), with larger increases for smaller diameter axons and for axons in larger fascicles. Further, thresholds increased by ~30%-180% for larger fascicle radii, yielding a larger increase with higher perineurium resistivity. Thresholds were largely insensitive to the transverse endoneurial resistivity, but estimates of the bulk resistivity increased with extracellular resistivity and axonal area fraction; the numerical and analytical estimates were in strong agreement except at high axonal area fractions, where structured axon placements that achieved tighter packing produced electric field inhomogeneities.

SIGNIFICANCE

We performed a systematic investigation of the effects of values and methods for modeling the perineurium and endoneurium on thresholds for neural stimulation and block. These results provide guidance for future modeling studies, including parameter selection, data interpretation, and comparison to experimental results.