Surgical complications of vagal nerve stimulation for intractable epilepsy

Findings from 26 cases

Takafumi Shimogawa, Takato Morioka, Tetsuro Sayama, Takeshi Hamamura, Kimiaki Hashiguchi, Nobuya Murakami

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Introduction : Vagal nerve stimulation (VNS) is a less invasive palliative treatment for intractable epilepsy and was approved for use in Japan in July 2010. Surgical complications of VNS such as vagal nerve dysfunction, cardiac arrhythmia with asystole, and vocal cord palsy as well as complications arising from fracture of the leads or generator and infections are well known in the West. The aim of the present report is to describe the surgical complications encountered in our hospital and discuss their countermeasures. Material and Methods : We reviewed the clinical records of 26 patients who underwent VNS therapy between March 2011 and June 2013. The cases involved 17 male and 9 female patients, including 8 children (<15 years of age). Results : Three patients (11.5%) experienced severe bradycardia and cardiac asystole following test stimulations of the vagal nerve with a stainless-steel surgical hook left in place, to extend the operative field. It was believed that the current spread through the hook and stimulated the cardiac branch of the vagal nerve. In an adult patient with severe intellectual disability, inappropriate dermatological therapy for a superficial purulent wound on the neck caused lead infection 10 months postoperatively. In a child with moderate intellectual disability, lead fracture was noted in association with rotation of the pulse generator at one month postoperatively. In the former case, the lead was cut off whilst the electrode and anchoring coil on the vagal nerve remained ; the whole VNS system was removed in the latter case. Subfascial implantation of the generator was recommended. In an adult patient, disconnection between the leads and generator head was noted at 10 months postoperatively. Conclusions : During intraoperative test stimulations of the vagal nerve, stainless-steel surgical hooks should be removed to avoid the spread of current. In intellectually disabled patients, the pulse generator should be placed in the subfascial area instead of the subcutaneous area, especially children. The connection between the leads and the generator should be performed with the aid of a microscope, after removal of the fluid and tissue.

Original languageEnglish
Pages (from-to)419-428
Number of pages10
JournalNeurological Surgery
Volume42
Issue number5
Publication statusPublished - 2014

Fingerprint

Vagus Nerve Stimulation
Stainless Steel
Heart Arrest
Surgical Instruments
Intellectual Disability
Vocal Cord Paralysis
Bradycardia
Infection
Palliative Care
Drug Resistant Epilepsy
Cardiac Arrhythmias
Japan
Electrodes
Neck
Head
Wounds and Injuries
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Shimogawa, T., Morioka, T., Sayama, T., Hamamura, T., Hashiguchi, K., & Murakami, N. (2014). Surgical complications of vagal nerve stimulation for intractable epilepsy: Findings from 26 cases. Neurological Surgery, 42(5), 419-428.

Surgical complications of vagal nerve stimulation for intractable epilepsy : Findings from 26 cases. / Shimogawa, Takafumi; Morioka, Takato; Sayama, Tetsuro; Hamamura, Takeshi; Hashiguchi, Kimiaki; Murakami, Nobuya.

In: Neurological Surgery, Vol. 42, No. 5, 2014, p. 419-428.

Research output: Contribution to journalReview article

Shimogawa, T, Morioka, T, Sayama, T, Hamamura, T, Hashiguchi, K & Murakami, N 2014, 'Surgical complications of vagal nerve stimulation for intractable epilepsy: Findings from 26 cases', Neurological Surgery, vol. 42, no. 5, pp. 419-428.
Shimogawa, Takafumi ; Morioka, Takato ; Sayama, Tetsuro ; Hamamura, Takeshi ; Hashiguchi, Kimiaki ; Murakami, Nobuya. / Surgical complications of vagal nerve stimulation for intractable epilepsy : Findings from 26 cases. In: Neurological Surgery. 2014 ; Vol. 42, No. 5. pp. 419-428.
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abstract = "Introduction : Vagal nerve stimulation (VNS) is a less invasive palliative treatment for intractable epilepsy and was approved for use in Japan in July 2010. Surgical complications of VNS such as vagal nerve dysfunction, cardiac arrhythmia with asystole, and vocal cord palsy as well as complications arising from fracture of the leads or generator and infections are well known in the West. The aim of the present report is to describe the surgical complications encountered in our hospital and discuss their countermeasures. Material and Methods : We reviewed the clinical records of 26 patients who underwent VNS therapy between March 2011 and June 2013. The cases involved 17 male and 9 female patients, including 8 children (<15 years of age). Results : Three patients (11.5{\%}) experienced severe bradycardia and cardiac asystole following test stimulations of the vagal nerve with a stainless-steel surgical hook left in place, to extend the operative field. It was believed that the current spread through the hook and stimulated the cardiac branch of the vagal nerve. In an adult patient with severe intellectual disability, inappropriate dermatological therapy for a superficial purulent wound on the neck caused lead infection 10 months postoperatively. In a child with moderate intellectual disability, lead fracture was noted in association with rotation of the pulse generator at one month postoperatively. In the former case, the lead was cut off whilst the electrode and anchoring coil on the vagal nerve remained ; the whole VNS system was removed in the latter case. Subfascial implantation of the generator was recommended. In an adult patient, disconnection between the leads and generator head was noted at 10 months postoperatively. Conclusions : During intraoperative test stimulations of the vagal nerve, stainless-steel surgical hooks should be removed to avoid the spread of current. In intellectually disabled patients, the pulse generator should be placed in the subfascial area instead of the subcutaneous area, especially children. The connection between the leads and the generator should be performed with the aid of a microscope, after removal of the fluid and tissue.",
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AU - Shimogawa, Takafumi

AU - Morioka, Takato

AU - Sayama, Tetsuro

AU - Hamamura, Takeshi

AU - Hashiguchi, Kimiaki

AU - Murakami, Nobuya

PY - 2014

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N2 - Introduction : Vagal nerve stimulation (VNS) is a less invasive palliative treatment for intractable epilepsy and was approved for use in Japan in July 2010. Surgical complications of VNS such as vagal nerve dysfunction, cardiac arrhythmia with asystole, and vocal cord palsy as well as complications arising from fracture of the leads or generator and infections are well known in the West. The aim of the present report is to describe the surgical complications encountered in our hospital and discuss their countermeasures. Material and Methods : We reviewed the clinical records of 26 patients who underwent VNS therapy between March 2011 and June 2013. The cases involved 17 male and 9 female patients, including 8 children (<15 years of age). Results : Three patients (11.5%) experienced severe bradycardia and cardiac asystole following test stimulations of the vagal nerve with a stainless-steel surgical hook left in place, to extend the operative field. It was believed that the current spread through the hook and stimulated the cardiac branch of the vagal nerve. In an adult patient with severe intellectual disability, inappropriate dermatological therapy for a superficial purulent wound on the neck caused lead infection 10 months postoperatively. In a child with moderate intellectual disability, lead fracture was noted in association with rotation of the pulse generator at one month postoperatively. In the former case, the lead was cut off whilst the electrode and anchoring coil on the vagal nerve remained ; the whole VNS system was removed in the latter case. Subfascial implantation of the generator was recommended. In an adult patient, disconnection between the leads and generator head was noted at 10 months postoperatively. Conclusions : During intraoperative test stimulations of the vagal nerve, stainless-steel surgical hooks should be removed to avoid the spread of current. In intellectually disabled patients, the pulse generator should be placed in the subfascial area instead of the subcutaneous area, especially children. The connection between the leads and the generator should be performed with the aid of a microscope, after removal of the fluid and tissue.

AB - Introduction : Vagal nerve stimulation (VNS) is a less invasive palliative treatment for intractable epilepsy and was approved for use in Japan in July 2010. Surgical complications of VNS such as vagal nerve dysfunction, cardiac arrhythmia with asystole, and vocal cord palsy as well as complications arising from fracture of the leads or generator and infections are well known in the West. The aim of the present report is to describe the surgical complications encountered in our hospital and discuss their countermeasures. Material and Methods : We reviewed the clinical records of 26 patients who underwent VNS therapy between March 2011 and June 2013. The cases involved 17 male and 9 female patients, including 8 children (<15 years of age). Results : Three patients (11.5%) experienced severe bradycardia and cardiac asystole following test stimulations of the vagal nerve with a stainless-steel surgical hook left in place, to extend the operative field. It was believed that the current spread through the hook and stimulated the cardiac branch of the vagal nerve. In an adult patient with severe intellectual disability, inappropriate dermatological therapy for a superficial purulent wound on the neck caused lead infection 10 months postoperatively. In a child with moderate intellectual disability, lead fracture was noted in association with rotation of the pulse generator at one month postoperatively. In the former case, the lead was cut off whilst the electrode and anchoring coil on the vagal nerve remained ; the whole VNS system was removed in the latter case. Subfascial implantation of the generator was recommended. In an adult patient, disconnection between the leads and generator head was noted at 10 months postoperatively. Conclusions : During intraoperative test stimulations of the vagal nerve, stainless-steel surgical hooks should be removed to avoid the spread of current. In intellectually disabled patients, the pulse generator should be placed in the subfascial area instead of the subcutaneous area, especially children. The connection between the leads and the generator should be performed with the aid of a microscope, after removal of the fluid and tissue.

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