Gad Lotan1, Michael Vaiman2. 1. Department of Pediatric Surgery, Assaf Harofeh Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel. 2. Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
Abstract
OBJECTIVES/HYPOTHESIS: The current article is dedicated to the surgical aspect of the vagus nerve stimulation (VNS) and our efforts to improve the surgical technique. The aim was to reduce the side effect/surgical complication rate as well as the time needed for this surgery. STUDY DESIGN: A case series. METHODS: The surgical data of 72 consecutive patients (age 4-14) who were operated for VNS device implantation from 2007 to 2014 were collected and analyzed. We designed the new surgical protocol that was implemented in all 72 cases and analyzed postsurgical side effects/complication rates. This protocol suggests low neck incision, detecting the vagus between the heads of the sternocleidomastoid muscle, a submuscular pocket for the device, and a short tunnel between it and the vagus electrodes. RESULTS: The implantation took about 40 minutes; 4.2% of the patients (n = 3) were afflicted by complications related to surgery; and one patient (1.4%) suffered from hardware malfunctions. Side effects related to VNS therapy itself occurred in seven cases (6.9%). CONCLUSION: To minimize laryngeal complications in implantation surgery for VNS devices, the surgical technique should be significantly modified, and lower neck incision could be implemented together with a submuscular pocket for the battery. LEVEL OF EVIDENCE: 4.
OBJECTIVES/HYPOTHESIS: The current article is dedicated to the surgical aspect of the vagus nerve stimulation (VNS) and our efforts to improve the surgical technique. The aim was to reduce the side effect/surgical complication rate as well as the time needed for this surgery. STUDY DESIGN: A case series. METHODS: The surgical data of 72 consecutive patients (age 4-14) who were operated for VNS device implantation from 2007 to 2014 were collected and analyzed. We designed the new surgical protocol that was implemented in all 72 cases and analyzed postsurgical side effects/complication rates. This protocol suggests low neck incision, detecting the vagus between the heads of the sternocleidomastoid muscle, a submuscular pocket for the device, and a short tunnel between it and the vagus electrodes. RESULTS: The implantation took about 40 minutes; 4.2% of the patients (n = 3) were afflicted by complications related to surgery; and one patient (1.4%) suffered from hardware malfunctions. Side effects related to VNS therapy itself occurred in seven cases (6.9%). CONCLUSION: To minimize laryngeal complications in implantation surgery for VNS devices, the surgical technique should be significantly modified, and lower neck incision could be implemented together with a submuscular pocket for the battery. LEVEL OF EVIDENCE: 4.
Authors: Alberto M Saibene; Elena Zambrelli; Carlotta Pipolo; Alberto Maccari; Giovanni Felisati; Elena Felisati; Francesca Furia; Aglaia Vignoli; Maria Paola Canevini; Enrico Alfonsi Journal: Eur Arch Otorhinolaryngol Date: 2016-10-13 Impact factor: 2.503