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Kaoutzani L, Goldman LV, Piper K, Kumar M, Vale FL. Revision and removal of vagus nerve stimulation systems: twenty-five years' experience. Acta Neurochir (Wien) 2023; 165:3913-3920. [PMID: 37957310 DOI: 10.1007/s00701-023-05875-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Epilepsy, a disease characterized by recurrent seizures, is a common chronic neurologic condition. Antiepileptic drugs (AED) are the mainstay of treatment for epilepsy. Vagus nerve stimulation (VNS) surgery is an adjuvant therapy for the treatment of drug refractory epilepsy (DRE). VNS revision and implant removal surgeries remain common. METHODS Using a single neurosurgeon data registry for epilepsy surgery, we retrospectively analyzed a total of 824 VNS surgeries. Patients were referred to two Level IV Comprehensive Epilepsy centers (from 08/1997 to 08/2022) for evaluation. Patients were divided into four groups: new device placement, revision surgery, removal surgery, and battery replacement for end-of-life of the generator. The primary endpoint was to analyze the reasons that led patients to undergo revision and removal surgeries. The time period from the index surgery to the removal surgery was also calculated. RESULTS The median age of patients undergoing any type of surgery was 34 years. The primary reason for revision surgeries was device malfunction, followed by patients' cosmetic dissatisfaction. There was no statistical sex-difference in revision surgeries. The median age and body mass index (BMI) of patients who underwent revision surgery were 38 years and 26, respectively. On the other hand, the primary reason for removal was lack of efficacy, followed again by cosmetic dissatisfaction. The survival analysis showed that 43% of VNS device remained in place for 5 years and 50% of the VNS devices were kept for 1533 days or 4.2 years. CONCLUSIONS VNS therapy is safe and well-tolerated. VNS revision and removal surgeries occur in less than 5% of cases. More importantly, attention to detail and good surgical technique at the time of the index surgery can increase patient satisfaction, minimize the need for further surgeries, and improve acceptance of the VNS technology.
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Affiliation(s)
- Lydia Kaoutzani
- Department of Neurosurgery, Medical College of Georgia, Augusta University (MCG-AU), Augusta, GA, USA
| | - Liam V Goldman
- Department of Neurosurgery, Medical College of Georgia, Augusta University (MCG-AU), Augusta, GA, USA
| | - Keaton Piper
- Department of Neurosurgery, University of South Florida (USF), Tampa, USA
| | - Manish Kumar
- Department of Neurosurgery, Medical College of Georgia, Augusta University (MCG-AU), Augusta, GA, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fernando L Vale
- Department of Neurosurgery, Medical College of Georgia, Augusta University (MCG-AU), Augusta, GA, USA.
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Saba ES, Rivero A. Pediatric vagal nerve stimulator explantation: A comprehensive literature review and tertiary care experience. Int J Pediatr Otorhinolaryngol 2023; 170:111603. [PMID: 37267661 DOI: 10.1016/j.ijporl.2023.111603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Patients with medically-refractory epilepsy who undergo vagal nerve stimulator (VNS) implantation to reduce seizure burden sometimes require device removal. Complete explantation refers to the removal of both the generator and vagal nerve leads, and is uncommonly performed by otolaryngologists due to the perceived risk associated with lead removal. This comprehensive literature review and case series studies safety outcomes among pediatric patients undergoing complete VNS explantation. STUDY DESIGN/SETTING Literature review and tertiary care case series. METHODS PubMed, Embase, Web of Science, and Google Scholar were searched to identify all articles involving VNS explantation prior to January 2023. A retrospective review of pediatric patients undergoing complete VNS explantation from 2009 to 2023 at our tertiary center was also conducted. RESULTS After screening, 36 articles were retained involving 399 patients (139 confirmed children) who underwent complete VNS explantation. 26 patients (6.5%) experienced 1+ peri/post-operative complications. These included temporary VF paresis or dysphonia (n = 14; 3.6%), permanent vocal fold (VF) paralysis/paresis (n = 6; 1.5%), internal jugular vein injury (n = 4; 1.0%), temporary dysphagia (n = 2; 0.50%), and cable-bowstring phenomenon (n = 1; 0.25%). Data from our tertiary care center revealed eight patients (6 M: 2 F) with a mean age of 11.4 ± 6.2 years. Devices were removed for clinical ineffectiveness (n = 2), infection (n = 2), lead failures (n = 2), and increased lead impedance (n = 2). Mean total length of implantation was 44.4 ± 40.3 months. Mean follow-up was 44.8 ± 35.2 months. No complications were identified. CONCLUSIONS Complete VNS device removal in pediatric patients is technically feasible with low reported complications. Working alongside neurosurgery, otolaryngologists offer unique expertise in dissection along the vagus nerve and may thus add value to the practice of VNS surgery.
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Affiliation(s)
- Elias S Saba
- Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA.
| | - Alexander Rivero
- Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA, 94611, USA
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Spindler P, Vajkoczy P, Schneider UC. Surgical revision after Vagus Nerve Stimulation. A case series. Epilepsy Behav Rep 2021; 15:100437. [PMID: 33912822 PMCID: PMC8063733 DOI: 10.1016/j.ebr.2021.100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
With increasing use of vagus nerve stimulation (VNS) as an adjunct treatment for drug-resistant epilepsy, revision surgery of VNS grows in importance. Indications for revision surgery are diverse and extend of surgery varies. We report a retrospective review on indications and complications of VNS revision surgery at our center. Of 90 VNS procedures 54.4% were revision surgeries. Among those the vast majority was due to depletion of the battery. The entire system was explanted in 15 patients, due to no beneficial effect detected (n = 4), due to irritating side effects (n = 4), and so further diagnostics could cbe carried out (n = 7). Interestingly in three of the patients who underwent further diagnostics, resective epilepsy surgery was performed. Surgical complications occurred in 8.2%. In our experience, revision surgery of VNS was a frequent and safe procedure. There is a need to carefully reviewthe initial indication for VNS implantation prior to revision surgery.
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Zhou H, Liu Q, Zhao C, Ma J, Ye X, Xu J. Lead Failure After Vagus Nerve Stimulation Implantation: Radiographic Examination and Revision Surgery. World Neurosurg 2018; 124:S1878-8750(18)32893-6. [PMID: 30593965 DOI: 10.1016/j.wneu.2018.12.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The present study assessed the most common types of lead failures, identified the causes, and discussed the potential procedures for revision surgery after vagus nerve stimulator implantation in patients with epilepsy. METHODS In a retrospective study during an 8-year period, 13 patients had undergone revision surgery because of lead failure. Lead failure was classified as either lead intrinsic damage or lead pin disengagement from the generator header. On the radiographic image, we defined a rear lead connector (RC) ratio that represented the portion of the rear lead connector in the header receptacle. It was used to quantitatively evaluate the mechanical failure of the lead-header interface. The optimal procedures to identify and manage lead failure were established. RESULTS All 13 patients presented with high lead impedance of ≥9 kOhms at the time of revision. Of 10 patients with lead damage, 7 had presented with an increased seizure frequency after a period of seizure remission. In contrast to lead damage occurring relatively late (>15 months), lead pin disengagement was usually found within the early months after device implantation. A significant association was found between an elevated RC ratio (≥35%) and lead pin disengagement. The microsurgical technique permitted removal or replacement of the lead without adverse effects. CONCLUSIONS The method of measuring the RC ratio developed in the present study is feasible for identifying lead disengagement at the generator level. Lead revision was an effective and safe procedure for patients experiencing lead failure.
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Affiliation(s)
- Hongyu Zhou
- Department of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Qiangqiang Liu
- Department of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chenjie Zhao
- Department of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Junfeng Ma
- Department of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaolai Ye
- Department of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiwen Xu
- Department of Functional Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Gigliotti MJ, Mao G, Dupré DA, Wilberger J. Vagal Nerve Stimulation: Indications for Revision in Adult Refractory Epilepsy. World Neurosurg 2018; 120:e1047-e1053. [DOI: 10.1016/j.wneu.2018.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 11/26/2022]
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Vaiman M, Heyman E, Lotan G. Neurological results of the modified treatment of epilepsy by stimulation of the vagus nerve. Childs Nerv Syst 2017; 33:2017-2022. [PMID: 28689344 DOI: 10.1007/s00381-017-3490-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The vagus nerve stimulation (VNS) is used for treatment of drug-resistant epilepsy but laryngeal side effects are common. We tried to improve VNS by modifying the implantation procedure. The aim was to reduce the rate of side effects that have prevented using VNS to its full capacity. METHODS We operated on 74 pediatric patients for VNS device implantation using a modified surgical protocol incorporating lower neck incision for electrode placement and 36 patients who were operated by standard technique were used for control group. We retrospectively analyzed reduction in frequency of seizures, reduction in severity of seizures (assessed by the shortened Ictal/post-ictal subscale of the Liverpool Seizure Severity Scale that included falling to the ground, postictal headache and sleepiness, incontinence, tongue biting, and injury during attack). RESULTS Using the new implantation technique, side effects related directly to VNS therapy occurred in six cases (8.1%) showing statistically sound improvement over the standard implantation technique (p ˂ 0.05). To achieve good results, the maximum stimulation (3.5 mA) was used in 24 patients (32.4%), with no laryngeal side effects detected. Twelve patients (16.2%) were seizure-free after the first year of VNS treatment. 74.3% of patients experienced a 50% reduction in seizure frequency and improved ictal or postictal activity. CONCLUSION To minimize laryngeal complications in implantation surgery for VNS devices, the surgical technique may be modified, and lower neck incision could be used. A low rate of laryngeal side effects allows using the VNS device to its full electrical capacity.
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Affiliation(s)
- Michael Vaiman
- Department of Otolaryngology - Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, 33 Shapiro Street, 59561, Bat Yam, Israel.
| | - Eli Heyman
- Pediatric Epilepsy Service, Pediatric Neurology Department, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Lotan
- Department of Pediatric Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Champeaux C, Landré E, Chassoux F, Mann MW, Devaux B, Turak B. Vagus Nerve Stimulation Removal or Replacement Involving the Lead and the Electrode: Surgical Technique, Institutional Experience and Outcome. World Neurosurg 2016; 99:275-281. [PMID: 28012885 DOI: 10.1016/j.wneu.2016.11.103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To analyze the outcome of epileptic patients who had redo surgery involving the vagus nerve stimulation's lead. METHODS We reviewed the clinical and surgical records of all patients who had a complete vagus nerve stimulation (VNS) removal or replacement or any redo surgical procedure involving the system lead at Sainte-Anne Hospital in Paris, France. RESULTS Between the years 1999 and 2016, 41 redo surgical procedures involving the lead or electrode were achieved, of which 23 were complete VNS explantations, 12 were complete system replacements, 5 were lead changes only, and 1 was isolated lead removal. 41% of the surgical procedures were achieved in female patients. This population has a median age at VNS implantation of 33.6 years (interquartile range [IQR], [21.4-38.6]. Median time between the VNS implantation and the redo surgery involving the lead was 4.9 years (IQR, 2.9-8). The reason for VNS removal was mainly a lack of clinical effectiveness. No preoperative or postoperative complications occurred after complete VNS system removal or lead replacement. The effectiveness of the VNS therapy remained unchanged after lead replacement. No vagus nerve injury was reported, nor did symptoms suggest that it was disabled. CONCLUSIONS Complete removal or replacement of the VNS system including the lead and the electrode is feasible and safe. These procedures should be offered to patients who would no longer benefit from the VNS or when only a lead change is needed.
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Affiliation(s)
| | | | | | | | - Bertrand Devaux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
| | - Baris Turak
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
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Pardo JV. Adjunctive vagus nerve stimulation for treatment-resistant bipolar disorder: managing device failure or the end of battery life. BMJ Case Rep 2016; 2016:bcr-2015-213949. [PMID: 26951440 DOI: 10.1136/bcr-2015-213949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The vagus nerve stimulation (VNS) device is used not only to treat refractory seizure disorders but also mood disorders; the latter indication received CE Mark approval in 2001 and Food and Drug Administration approval in 2005. Original estimates for the end of battery life (EOBL) were approximately 6-10 years. Many neuropsychiatric patients have or will soon face EOBL. A patient with severe, life-threatening, treatment-resistant bipolar disorder underwent 9 years of stable remission following 20 months of adjunctive VNS. The device ceased operation at EOBL. Because of logistical issues, re-initiation of VNS was delayed over several months. The patient relapsed with depression, mania and mixed states, and regained remission 17 months after device replacement. This case dictates prudence in managing stable patients in remission with VNS. If the device malfunctions, urgent surgical replacement is warranted with subsequent rapid titration to previous parameters as tolerated. Several months' delay may trigger relapse and prove difficult to re-establish remission.
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Affiliation(s)
- José V Pardo
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA Minneapolis Veterans Health Care System, Minneapolis, Minnesota, USA
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Salerno G, Passamonti C, Cecchi A, Zamponi N. Vagus nerve stimulation during pregnancy: an instructive case. Childs Nerv Syst 2016; 32:209-11. [PMID: 26350804 DOI: 10.1007/s00381-015-2897-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about the safety of vagus nerve stimulation during pregnancy. CASE REPORT Herein we report the case of a young woman affected by childhood-onset partial epilepsy, obesity, and depression in which a malfunctioning of VNS was detected during pregnancy. Although device functioning was not optimal during the critical period of organogenesis, no morphological abnormalities of the fetus were detected. CONCLUSION A confirmation of VNS safety may increase its use during pregnancy, thus reducing possible systemic effects of antiepileptic drugs and antidepressants on the women and the baby.
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Aalbers MW, Rijkers K, Klinkenberg S, Majoie M, Cornips EM. Vagus nerve stimulation lead removal or replacement: surgical technique, institutional experience, and literature overview. Acta Neurochir (Wien) 2015; 157:1917-24. [PMID: 26335753 DOI: 10.1007/s00701-015-2547-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/07/2015] [Indexed: 11/18/2022]
Abstract
Background With the growing use of vagus nerve stimulation (VNS) as a treatment for refractory epilepsy, there is a growing demand for complete removal or replacement of the VNS system. We evaluate the safety and efficacy of complete removal or replacement of the VNS system and provide an extensive description of our surgical technique. Methods We retrospectively reviewed our patient registry for all VNS surgeries performed between January 2007 (the year of our first complete removal) and May 2014. In order to assess patient satisfaction, a written questionnaire was sent to patients or their caregivers. Additionally, we reviewed all literature on this topic. Results The VNS system was completely removed in 22 patients and completely replaced in 13 patients. There were no incomplete removals. Revision surgery was complicated by a small laceration of the jugular vein in two patients and by vocal cord paralysis in one patient. Seizure frequency was unaltered or improved after revision surgery. Electrode-related side effects all improved after revision surgery. Twenty-one studies reported a total of 131 patients in whom the VNS system was completely removed. In 95 patients, the system was subsequently replaced. The most frequently reported side effect was vocal cord paresis, which occurred in four patients. Conclusions Complete removal or replacement of the VNS system including lead and coils is feasible and safe. Although initial results seem promising, further research and longer follow-up are needed to assess whether lead replacement may affect VNS effectiveness. Electronic supplementary material The online version of this article (doi:10.1007/s00701-015-2547-9) contains supplementary material, which is available to authorized users.
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Hammer N, Glätzner J, Feja C, Kühne C, Meixensberger J, Planitzer U, Schleifenbaum S, Tillmann BN, Winkler D. Human vagus nerve branching in the cervical region. PLoS One 2015; 10:e0118006. [PMID: 25679804 PMCID: PMC4332499 DOI: 10.1371/journal.pone.0118006] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/05/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vagus nerve stimulation is increasingly applied to treat epilepsy, psychiatric conditions and potentially chronic heart failure. After implanting vagus nerve electrodes to the cervical vagus nerve, side effects such as voice alterations and dyspnea or missing therapeutic effects are observed at different frequencies. Cervical vagus nerve branching might partly be responsible for these effects. However, vagus nerve branching has not yet been described in the context of vagus nerve stimulation. MATERIALS AND METHODS Branching of the cervical vagus nerve was investigated macroscopically in 35 body donors (66 cervical sides) in the carotid sheath. After X-ray imaging for determining the vertebral levels of cervical vagus nerve branching, samples were removed to confirm histologically the nerve and to calculate cervical vagus nerve diameters and cross-sections. RESULTS Cervical vagus nerve branching was observed in 29% of all cases (26% unilaterally, 3% bilaterally) and proven histologically in all cases. Right-sided branching (22%) was more common than left-sided branching (12%) and occurred on the level of the fourth and fifth vertebra on the left and on the level of the second to fifth vertebra on the right side. Vagus nerves without branching were significantly larger than vagus nerves with branches, concerning their diameters (4.79 mm vs. 3.78 mm) and cross-sections (7.24 mm2 vs. 5.28 mm2). DISCUSSION Cervical vagus nerve branching is considerably more frequent than described previously. The side-dependent differences of vagus nerve branching may be linked to the asymmetric effects of the vagus nerve. Cervical vagus nerve branching should be taken into account when identifying main trunk of the vagus nerve for implanting electrodes to minimize potential side effects or lacking therapeutic benefits of vagus nerve stimulation.
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Affiliation(s)
- Niels Hammer
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Juliane Glätzner
- Department of Neurosurgery, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Christine Feja
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Christian Kühne
- Department of Cardiology, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Jürgen Meixensberger
- Department of Neurosurgery, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Uwe Planitzer
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
- Department of Neurosurgery, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Stefan Schleifenbaum
- Department of Orthopedic, Trauma and Reconstructive Surgery, University Clinic of Leipzig, Leipzig, Germany
| | | | - Dirk Winkler
- Department of Neurosurgery, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
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Lotan G, Vaiman M. Treatment of epilepsy by stimulation of the vagus nerve from Head-and-Neck surgical point of view. Laryngoscope 2014; 125:1352-5. [PMID: 25429912 DOI: 10.1002/lary.25064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/01/2014] [Accepted: 11/05/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The current article is dedicated to the surgical aspect of the vagus nerve stimulation (VNS) and our efforts to improve the surgical technique. The aim was to reduce the side effect/surgical complication rate as well as the time needed for this surgery. STUDY DESIGN A case series. METHODS The surgical data of 72 consecutive patients (age 4-14) who were operated for VNS device implantation from 2007 to 2014 were collected and analyzed. We designed the new surgical protocol that was implemented in all 72 cases and analyzed postsurgical side effects/complication rates. This protocol suggests low neck incision, detecting the vagus between the heads of the sternocleidomastoid muscle, a submuscular pocket for the device, and a short tunnel between it and the vagus electrodes. RESULTS The implantation took about 40 minutes; 4.2% of the patients (n = 3) were afflicted by complications related to surgery; and one patient (1.4%) suffered from hardware malfunctions. Side effects related to VNS therapy itself occurred in seven cases (6.9%). CONCLUSION To minimize laryngeal complications in implantation surgery for VNS devices, the surgical technique should be significantly modified, and lower neck incision could be implemented together with a submuscular pocket for the battery. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Gad Lotan
- Department of Pediatric Surgery, Assaf Harofeh Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Michael Vaiman
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel
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