Artikel
Revision of vagal nerve stimulation (VNS) electrodes
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Autoren
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Stefanie Hammersen
- Klinik für Neurochirurgie, Vivantes Klinikum im Friedrichshain Berlin
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Markus Schomacher
- Klinik für Neurochirurgie, Charité – Universitätsmedizin Berlin
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Katrin Bohlmann
- Epilepsieklinik Tabor, Bernau bei Berlin
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Dag Moskopp
- Klinik für Neurochirurgie, Vivantes Klinikum im Friedrichshain Berlin
| Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: Revision of vagal nerve electrodes is considered to be a risky procedure, which is officially not recommended by the manufacturer until now.
Method: A retrospective analysis of revision surgery in VNS was performed from 2003 to 2013. 30 cases of VNS revisions, including 18 explantations were reviewed. The indications for VNS revision were device malfunction with increased impedance, missing therapeutic benefit from the device, and infection.
Results: The time from initial VNS implantation to revision ranged from 3 to 62 months. The microsurgical revision was performed by SH in all cases. The entire VNS electrode was replaced on the left side in 12 cases. One case had after 18 month a second replacement of the electrode again due to device malfunction. Intraoperatively there was a bleeding from internal jugular vein without sequel, in one case. In another case the explantation was incomplete due to scar tissue. Post-operatively, there was no vagal nerve injury or dysphagia in all patients. All cases demonstrated fibrotic scar tissue around the vagal nerve.
Conclusions: Revision of vagal nerve stimulation electrodes with replacement is a therapeutic option with a tolerable rate of complications. It requires a high degree of microsurgical skills considering peripheral nerve and vascular surgery.
