Article
Revision surgery in patients with vagus-nerve-stimulation system
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Authors
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Esther Pölking
- Universitätsklinik für Neurochirurgie, Medizinischer Campus Carl-von-Ossietzky-Universität Oldenburg, Evangelisches Krankenhaus Oldenburg
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Juan Manuel Vinas-Rios
- Universitätsklinik für Neurochirurgie, Medizinischer Campus Carl-von-Ossietzky-Universität Oldenburg, Evangelisches Krankenhaus Oldenburg
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Thomas Schmidt
- Universitätsklinik für Neurochirurgie, Medizinischer Campus Carl-von-Ossietzky-Universität Oldenburg, Evangelisches Krankenhaus Oldenburg
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Wiebke Aumann
- Universitätsklinik für Neurochirurgie, Medizinischer Campus Carl-von-Ossietzky-Universität Oldenburg, Evangelisches Krankenhaus Oldenburg
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Thomas Kretschmer
- Universitätsklinik für Neurochirurgie, Medizinischer Campus Carl-von-Ossietzky-Universität Oldenburg, Evangelisches Krankenhaus Oldenburg
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Christian Heinen
- Universitätsklinik für Neurochirurgie, Medizinischer Campus Carl-von-Ossietzky-Universität Oldenburg, Evangelisches Krankenhaus Oldenburg
| Published: | June 2, 2015 |
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Outline
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Objective: In contrast to simple generator replacement due to battery weakness, revision or exchange of the whole vagus nerve stimulation (VNS) system in case of lead break or displacement is surgically more challenging. This is especially true when electrodes have to be dissected without harming the vagal nerve and its branches and the major vessels have to be preserved within scar tissue.
With this abstract we report our pre- and intra-operative findings, complications and results in a study of n=6 cases.
Method: Overall n= 25 patients underwent VNS-surgery from 2013-14 of whom n=12 were new implantations, n=7 required a generator exchange only and n=6 necessitated removal and reimplantation of the whole system. The latter were retrospectively assessed addressing preoperative symptoms, imaging findings, change of impedance, time from implantation to revision surgery, intra-operative findings, complications and follow-up.
Results: In n=6 the whole system including the lead needed microsurgical revision. Pre-operative symptoms consisted of a progression of seizure frequency and intensity and depression respectively. X-ray exams showed damaged leads in n=3 patients. Mean time from prior surgery to revision was 7.3 years. During operation, we detected heavy scarring and fibrosis between the electrode and the nerve in all cases, in 1 case a clear lead break was obvious. In one patient laceration of the scarred internal jugular vein needed vessel repair which was successful. Mean surgery time was 139 min. N=2 patients suffered from temporary vocal cord palsy which interestingly occurred with a delay of 10-14 days after revision surgery. N=1 patient experienced transient impaired deglutition.
Conclusions: According to our experience, revision surgery of the whole VNS-system including the removal of the whole primary implanted system, is safe and feasible. Complications such as vocal cord palsy have to be kept in mind and should explicitly be discussed prior to surgery, but the risk of permanent neurological deficits seems to be low. Further investigations are required to get significant results with a larger number of cases.
