gms | German Medical Science

66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Friendship Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

7. - 10. Juni 2015, Karlsruhe

Indications for complete explantation of vagal nerve stimulator devices and procedural complications

Meeting Abstract

  • Lasse Dührsen - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Deutschland
  • Bert Voges - Epilepsiezentrum, Evangelisches Krankenhaus Hamburg-Alsterdorf
  • Stefan Stodieck - Epilepsiezentrum, Evangelisches Krankenhaus Hamburg-Alsterdorf
  • Manfred Westphal - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Deutschland
  • Tobias Martens - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMI.05.03

doi: 10.3205/15dgnc277, urn:nbn:de:0183-15dgnc2773

Veröffentlicht: 2. Juni 2015

© 2015 Dührsen et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Vagal nerve stimulation (VNS) is a well-accepted therapeutical device for treating medically intractable seizures with no resectable focus. Implantation is a standard procedure, whereas explantation of the electrodes is more time-consuming due to scarring at the vagal nerve. However, as the electrodes inhibit a high-resolution MRI and new therapeutic options occur, indications for explantation of the whole device including electrodes are indicated with increasing frequency. Only few data concerning procedural safety and success rates are existing in literature.

Method: We performed a retrospective analysis of our own series of patients with explantation of VNS and electrodes. Indications, procedural complications and success rates were analyzed.

Results: 161 VNS surgeries were performed at our center between 2002 and October 2014. Sixteen of these were complete explantations including electrodes.

Indications were lead fracture (n=7) or no significant improvement in seizure control (n=9), respectively. All VNS could be explanted completely. Anchor and contact coils had to be taken out piecemeal under the microscope in all cases due to severe scare tissue around the vagal nerve. One patient showed postoperatively a persistent hoarseness based on a paralysis of the recurrent nerve. No other considerable complications were observed.

In three patients a new VNS was implanted in the same anesthesia on the same side. All other patients received a 3 Tesla MRI of the neurocranium postoperatively. Six of them were assigned for deep brain stimulation (DBS) and one patient got a new VNS in a second procedure. The remaining six patients were identified as candidates for epilepsy surgery resections and were operated on in a second step procedure.

Conclusions: Complete explantation of VNS is a safe procedure that enables a re-evaluation of surgical candidates for epilepsy surgery in selected cases or allows the implantation of electrodes for DBS, respectively. Re-implantation of VNS is possible in same anesthesia or in a second step procedure on the same side.