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25-11-2022 | Vagus Nerve Stimulation | Original Article

Vagus nerve stimulator revision in pediatric epilepsy patients: a technical note and case series

Authors: Melissa A. LoPresti, Jonathan Huang, Nathan A. Shlobin, Daniel J. Curry, Howard L. Weiner, Sandi K. Lam

Published in: Child's Nervous System | Issue 2/2023

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Abstract

Introduction

Vagus nerve stimulation (VNS) is an adjunctive treatment in children with intractable epilepsy. When lead replacement becomes necessary, the old leads are often truncated and retained and new leads are implanted at a newly exposed segment of the nerve. Direct lead removal and replacement are infrequently described, with outcomes poorly characterized. We aimed to describe our experience with feasibility of VNS lead removal and replacement in pediatric patients.

Methods

Retrospective review examined 14 patients, at a single, tertiary-care, children’s hospital, who underwent surgery to replace VNS leads, with complete removal of the existing lead from the vagus nerve and placement of a new lead on the same segment of the vagus nerve, via blunt and sharp dissection without use of electrocautery. Preoperative characteristics, stimulation parameters, and outcomes were collected.

Results

Mean age at initial VNS placement was 7.6 years (SD 3.5, range 4.5–13.4). Most common etiologies of epilepsy were genetic (5, 36%) and cryptogenic (4, 29%). Lead replacement was performed at a mean of 6.0 years (SD 3.8, range 2.1–11.7) following initial VNS placement. Reasons for revision included VNS lead breakage or malfunction. There were no perioperative complications, including surgical site infection, voice changes, dysphagia, or new deficits postoperatively. Stimulation parameters after replacement surgery at last follow-up were similar compared to preoperatively, with final stimulation parameters ranging from 0.25 mA higher to 1.5 mA lower to maintain baseline seizure control. The mean length of follow-up was 7.9 years (SD 3.5, range 3.1–13.7).

Conclusion

Removal and replacement of VNS leads are feasible and can be safely performed in children. Further characterization of surgical technique, associated risk, impact on stimulation parameters, and long-term outcomes are needed to inform best practices in VNS revision.
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Metadata
Title
Vagus nerve stimulator revision in pediatric epilepsy patients: a technical note and case series
Authors
Melissa A. LoPresti
Jonathan Huang
Nathan A. Shlobin
Daniel J. Curry
Howard L. Weiner
Sandi K. Lam
Publication date
25-11-2022
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 2/2023
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-022-05769-0

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