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proLékaře.cz / Journals / Perspectives in Surgery / 2020 - 7

Implanted vagus nerve stimulation in 126 patients: surgical technique and complications

Czech version

Authors: M. Bláha;  M. Tichý
Authors‘ workplace: Neurochirurgická klinika dětí a dospělých 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Motol
Published in: Rozhl. Chir., 2020, roč. 99, č. 7, s. 304-310.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2020.99.7.304–310

Overview

Introduction: Vagus nerve stimulation is a palliative treatment for patients with refractory epilepsy to reduce the frequency and intensity of seizures. A bipolar helical electrode is placed around the left vagus nerve at the cervical level and is connected to the pulse generator placed in a subcutaneous pocket, most commonly in the subclavian region.

Methods: Between March 1998 and October 2019, we performed 196 procedures related to the vagal nerve stimulation at the Neurosurgery Department in Motol University Hospital. Of these, 126 patients were vagal nerve stimulator implantation surgeries for intractable epilepsy. The cases included 69 female and 57 male patients with mean age at the time of the implantation surgery 22±12.4 years (range 2.1−58.4 years).

Results: Nine patients (7.1%) were afflicted by complications related to implantation. Surgical complications included postoperative infection in 1.6%, VNS-associated arrhythmias in 1.6%, jugular vein bleeding in 0.8% and vocal cord paresis in 2.4%. One patient with vocal cord palsy also suffered from severe dysphagia. One patient (0.8%) did not tolerate extra stimulation with magnet due to a prolonged spasm in his throat. The extra added benefit of vagus stimulation in one patient was a significant reduction of previously regular severe headaches.

Conclusion: Vagus nerve stimulation is an appropriate treatment for patients with drug-resistant epilepsy who are not candidates for focal resective surgery. Implantation of the vagus nerve stimulator is a relatively safe operative procedure.

Keywords:

epilepsy − epilepsy surgery − vagus nerve stimulation – VNS − complications

Sources
  1. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE Official report: A practical clinical definition of epilepsy. Epilepsia 2014;55(4):475−482. doi:10.1111/epi.12550.
  2. Marusič P, Krijtová H. Kompenzovaný pacient s epilepsií − cesta a cíl. Neurol pro praxi 2011;12(6):407−410.
  3. Hovorka J. Farmakologická léčba epilepsie podle „guidelines“? Neurol pro praxi 2009;10(4):228−236.
  4. Brázdil M, Hadač J. Definice farmakorezistentní epilepsie, příčiny intraktability. In: Brázdil M, Hadač J, Marusič P, eds. Farmakorezistentní epilepsie. Triton, Praha 2011:11−22.
  5. Penry JK, Dean JC. Prevention of intractable partial seizures by intermittent vagal stimulation in humans: Preliminary results. Epilepsia 1990;31:S40-S43. doi:10.1111/j.1528-1157.1990.tb05848.x.
  6. Ben‐Menachem E, Mañon‐Espaillat R, Ristanovic R, et al. Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. Epilepsia 1994;35(3):616−626. doi:10.1111/j.1528-1157.1994.tb02482.x.
  7. Ramsay RE, Uthman BM, Augustinsson LE, et al. Vagus nerve stimulation for treatment of partial seizures: 2. safety, side effects, and tole­rability. Epilepsia 1994;35(3):627−636. doi:10.1111/j.1528-1157.1994.tb02483.
  8. Samadani U, Baltuch G. Vagus nerve stimu­lation. In: Baltuch G, Villemure J, eds. Operative techniques in epilepsy surgery. Thieme, New York 2009:149−157.
  9. Ben-Menachem E, Hamberger A, Hedner T, et al. Effects of vagus nerve stimulation on amino acids and other metabolites in the CSF of patients with partial seizures. Epilepsy Res 1995;20(3):221−227. doi:10.1016/0920-1211(94)00083-9.
  10. Landy HJ, Ramsay RE, Slater J, et al. Vagus nerve stimulation for complex partial seizures: Surgical technique, safety, and efficacy. J Neurosurg 1993;78(1):26−31. doi:10.3171/jns.1993.78.1.0026.
  11. Ng M, Devinsky O. Vagus nerve stimulation for refraktory idiopathic generalised epilepsy. Seizure 2004;13(3):176−178. doi:10.1016/S1059-1311(03)00147-X.
  12. Nei M, O’Connor M, Liporace J, et al. Refractory generalized seizures: Response to corpus callosotomy and vagal nerve stimulation. Epilepsia 2006;47(1):115−122. doi:10.1111/j.1528-1167.2006.00377.x.
  13. Rosenfeld WE, Roberts DW. Tonic andatonic seizures: What’s next – VNS or callosotomy? Epilepsia 2009;50(SUPPL. 8):25−30. doi:10.1111/j.1528-1167.2009.02232.x.
  14. Benbadis SR, Tatum WO, Vale FL. When drugs don’t work: An algorithmic approach to medically intractable epilepsy. Neurology 2000;55(12):1780−1784. doi:10.1212/WNL.55.12.1780.
  15. Yamamoto T. Vagus nerve stimulation therapy: Indications, programing, and outcomes. Neurol Med Chir (Tokyo) 2015;55(5):407−415. doi:10.2176/nmc.ra.2014-0405.
  16. Elliott RE, Morsi A, Kalhorn SP, et al. Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: long-term outcomes and predictors of response. Epilepsy Behav 2011;20(1):57−63. doi:10.1016/j.yebeh.2010.10.017.
  17. Elliott RE, Rodgers SD, Bassani L, et al. Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases. J Neurosurg Pediatr 2011;7(5):491−500. doi:10.3171/2011.2.PEDS10505.
  18. Lancman G, Virk M, Shao H, et al. Vagus nerve stimulation vs. corpus callosotomy in thetreatment of Lennox-Gastaut syndrome: a meta-analysis. Seizure 2013;22(1):3−8. doi:10.1016/j.seizure.2012.09.014.
  19. Spanaki MV, Allen LS, Mueller WM, et al. Vagus nerve stimulation therapy: 5-year or greater outcome at a university-based epilepsy center. Seizure 2004;13(8):587−590. doi:10.1016/j.seizure.2004.01.009.
  20. DeGiorgio CM, Schachter SC, Handforth A, et al. Prospective long-term study of vagus nerve stimulation for the treatment of refractory seizures. Epilepsia 2000;41(9):1195−1200. doi:10.1111/j.1528-1157.2000.tb00325.x.
  21. Chrastina J, Novak Z, Zeman T, et al. Single-center long-term results of vagus nerve stimulation for epilepsy: A 10-17 year follow-up study. Seizure 2018;59:41−47. doi:10.1016/j.seizure.2018.04.022.
  22. Englot DJ, Rolston JD, Wright CW, et al. Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy. Neurosurgery. 2016;79(3):345−353.. Neurosurgery. 2016;79(3):345−353. doi:10.1227/NEU.0000000000001165.
  23. Reid SA. Surgical technique for implantation of the neurocybernetic prosthesis. Epilepsia 1990;31:S38−S39. doi:10.1111/j.1528-1157.1990.tb05847.x.
  24. Kuba R, Brázdil M, Kalina M, et al. Vagus nerve stimulation: Longitudinal follow-up of patients treated for 5 years. Seizure 2009;18(4):269−274. doi:10.1016/j.seizure.2008.10.012.
  25. Hallböök T, Lundgren J, Stjernqvist K, et al. Vagus nerve stimulation in 15 children with therapy resistant epilepsy; its impact on cognition, quality of life, behaviour and mood. Seizure 2005;14(7):504−513. doi:10.1016/j.seizure.2005.08.007.
  26. Malow BA, Edwards J, Marzec M, et al. Vagus nerve stimulation reduces daytime sleepiness in epilepsy patients. Neurology 2001;57(5):879−884. doi:10.1212/wnl.57.5.879.
  27. Dodrill CB, Morris GL. Effects of vagal nerve stimulation on cognition and quality of life in epilepsy. Epilepsy Behav. 2001;2(1):46-53. doi:10.1006/ebeh.2000.0148.
  28. Ghacibeh GA, Shenker JI, Shenal B, et al. The influence of vagus nerve stimulation on memory. Cogn Behav Neurol. 2006;19(3):119−122. doi:10.1097/01.wnn.0000213908.34278.7d.
  29. Sirven JI, Sperling M, Naritoku D, et al. Vagus nerve stimulation therapy for epilepsy in older adults. Neurology 2000;54(5):1179-1182. doi:10.1212/WNL.54.5.1179.
  30. Helmers SL, Wheless JW, Frost M, et al. Vagus nerve stimulation therapy in pediatric patients with refraktory epilepsy: Retrospective study. J Child Neurol 2001;16(11):843−848. doi:10.1177/08830738010160111101.
  31. Uthman BM, Wilder BJ, Penry JK, et al. Treatment of epilepsy by stimulation of the vagus nerve. Neurology 1993;43(7):1338−1345. doi:10.1212/wnl.43.7.1338.
  32. Randall WC, Ardell JL, Becker DM. Differential responses accompanying sequential stimulation and ablativ of vagal branches to dog heart. Am J Physiol – Hear Circ Physiol 1985;18(1). doi:10.1152/ajpheart.1985.249.1.h133.
  33. Krahl SE, Senanayake SS, Handforth A. Right-sided vagus nerve stimulation reduces generalized seizure severity in rats as effectively as left-sided. Epilepsy Res 2003;56(1):1−4. doi:10.1016/S0920-1211(03)00122-0.
  34. Navas M, Navarrete EG, Pascual JM, et al. Treatment of refractory epilepsy in adult patients with right-sided vagus nerve stimulation. Epilepsy Res 2010;90(1-2):1-7. doi:10.1016/j.eplepsyres.2010.04.007.
  35. McGregor A, Wheless J, Baumgartner J, et al. Right-sided vagus nerve stimulation as a treatment for refractory epilepsy in humans. Epilepsia 2005;46(1):91−96. doi:10.1111/j.0013-9580.2005.16404.x.
  36. Spuck S, Nowak G, Renneberg A, et al. Right-sided vagus nerve stimulation in humans: An effective therapy? Epilepsy Res 2008;82(2-3):232−234. doi:10.1016/j.eplepsyres.2008.08.003.
  37. Kumar R, Winston KR, Folzenlogen Z. Experience with a low single cervical incision for implantation of a vagus nerve stimulator: Technique and advantages. World Neurosurg 2015;84(6):1785−1789. doi:10.1016/j.wneu.2015.07.058.
  38. Patil AA, Chand A, Andrews R. Single incision for implanting a vagal nerve stimulator system (vnss): Technical note. Surg Neurol 2001;55(2):103−105. doi:10.1016/S0090-3019(01)00350-0.
  39. Bauman JA, Ridgway EB, Devinsky O, et al. Subpectoral implantation of the vagus nerve stimulator. Neurosurgery 2006;58(4 Suppl 2):ONS-322-5; discussion ONS-325-6. doi:10.1227/01.NEU.0000208975.19581.8A.
  40. Le H, Chico M, Hecox K, Frim D. Interscapular placement of a vagal nerve stimulator pulse generator for prevention of wound tampering. Pediatr Neurosurg. 2002;36(3):164−166. doi:10.1159/000048375.
  41. Révész D, Rydenhag B, Ben-Menachem E. Complications and safety of vagus nerve stimulation: 25 years of experience at a single center. J Neurosurg Pediatr. 2016;18(1):97−104. doi:10.3171/2016.1.PEDS15534.
  42. Spuck S, Tronnier V, Orosz I, et al. Operative and technical complications of vagus nerve stimulator implantation. Neurosurgery 2010;67(SUPPL. 2):489−494. doi:10.1227/NEU.0b013e3181f88867.
  43. Kahlow H, Olivecrona M. Complications of vagal nerve stimulation for drug-resistant epilepsy: a single center longitudinal study of 143 patients. Seizure 2013;22(10):827−833. doi:10.1016/j.seizure.2013.06.011.
  44. Ben-Menachem E. Vagus-nerve stimulation for the treatment of epilepsy. Lancet Neurol 2002;1(8):477−482. doi:10.1016/S1474-4422(02)00220-X.
  45. Couch JD, Gilman AM, Doyle WK. Long-term expectationsof vagus nerve stimulation: A look at battery replacement and revision surgery. Neurosurgery 2016;78(1):42−46. doi:10.1227/NEU.0000000000000985.
  46. Yang J, Phi JH. The present and future of vagus nerve stimulation. J Korean Neurosurg Soc 2019;62(3):344−352. doi:10.3340/jkns.2019.0037.
  47. Patel NC, Edwards MS. Vagal nerve stimulator pocket infections. Pediatr Infect Dis J 2004;23(7):681−683. doi:10.1097/01.inf.0000131632.25375.c7.
  48. Kuroda N, Fujimoto A, Okanishi T, et al. Low body mass index and low intelligence quotient are infection risk factors in vagus nerve stimulation. World Neurosurg 2019;130:e839−e845. doi:10.1016/j.wneu.2019.06.235.
  49. Aalbers MW, Rijkers K, Klinkenberg S, et al. Vagus nerve stimulation lead removal or replacement: surgical technique, institutional experience, and literature overview. Acta Neurochir (Wien) 2015;157(11):1917−1924. doi:10.1007/s00701-015-2547-9.
  50. Giordano F, Zicca A, Barba C, et al. Vagus nerve stimulation: Surgical technique of implantation and revision and related morbidity. Epilepsia 2017;58:85−90. doi:10.1111/epi.13678.
  51. Air EL, Ghomri YM, Tyagi R, et al. Management of vagal nerve stimulator infections: do they need to be removed? J Neurosurg Pediatr 2009;3(1):73−78. doi:10.3171/2008.10.PEDS08294.
  52. Jacqueline C, Caillon J. Impact of bacterial biofilm on the treatment of prosthetic joint infections. J Antimicrob Chemother 2014;69 Suppl 1:i37−40. doi:10.1093/jac/dku254.
  53. Jørgensen NP, Skovdal SM, Meyer RL, et al. Rifampicin-containing combinations are superior to combinations of vancomycin, linezolid and daptomycin against Staphylococcus aureus biofilm infection in vivo and in vitro. Pathog Dis 2016;74(4):ftw019. doi:10.1093/femspd/ftw019.
  54. Zimmerli W, Sendi P. Role of rifampin against Staphylococcal biofilm infections in vitro, in animal models, and in orthopedic-device-related infections. Antimicrob Agents Chemother 2019;63(2). doi:10.1128/AAC.01746-18.
  55. Wozniak SE, Thompson EM, Selden NR. Vagal nerve stimulator infection: a lead-salvage protocol. J Neurosurg Pediatr 2011;7(6):671−675. doi:10.3171/2011.4.PEDS10556.
  56. Ortler M, Luef G, Kofler A, et al. Deep wound infection after vagus nerve stimulator implantation: treatment without removal of the device. Epilepsia 2001;42(1):133−135. doi:10.1046/j.1528-1157.2001.23800.x.
  57. Ardesch JJ, Buschman HPJ, van der Burgh PH, et al. Cardiac responses of vagus nerve stimulation: Intraoperative bradycardia and subsequent chro­nic stimulation. Clin Neurol Neurosurg 2007;109(10):849−852. doi:10.1016/j.clineuro.2007.07.024.
  58. Schevchuck A, West MB. Late-onset advanced heart block due to vagal nerve stimulation. Am J Ther 2014;21(6):545−547. doi:10.1097/MJT.0b013e31828df0c7.
  59. Seçen AE. Lead fractures after vagal nerve stimulat or implantation. J Turkish Epilepsi Soc. 2018;25(3):136−140. doi:10.14744/epilepsi.2018.97659.
  60. Tran Y, Shah AK, Mittal S. Lead breakage and vocal cord paralysis following blunt neck trauma in a patient with vagal nerve stimulator. J Neurol Sci. 2011;304(1−2):132−135. doi:10.1016/j.jns.2011.02.022.
  61. Rong P, Liu A, Zhang J, et al. Transcutaneous vagus nerve stimulation for refractory epilepsy: a randomized controlled trial. Clin Sci (Lond) April 2014. doi:10.1042/CS20130518.
  62. Bucksot JE, Wells AJ, Rahebi KC, et al. Flat electrode contacts for vagus nerve stimulation. PLoSOne 2019;14(11):e0215191. doi:10.1371/journal.pone.0215191.
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