Jason Labuschagne1,2, Denis Mutyaba3,4, Jacques Nel5, Claudia Casieri6. 1. Department of Neurosurgery, University of the Witwatersrand, Johannesburg, South Africa. Jason.labuschagne@icloud.com. 2. Department of Paediatric Neurosurgery, Nelson Mandela Children's Hospital, Johannesburg, South Africa. Jason.labuschagne@icloud.com. 3. Department of Neurosurgery, University of the Witwatersrand, Johannesburg, South Africa. 4. Department of Paediatric Neurosurgery, Nelson Mandela Children's Hospital, Johannesburg, South Africa. 5. Clinical Neurophysiologist, Jacques Nel and Associates, Atterbury Estate, Pretoria, South Africa. 6. Department of Neurophysiology, Nelson Mandela Children's Hospital, Johannesburg, South Africa.
Abstract
PURPOSE: The treatment of refractory epilepsy by vagus nerve stimulation (VNS) is a well-established therapy. Complications following VNS insertion may be procedure-related or stimulation-related. Herein, we describe our technique of intra-operative neuro-monitoring (IONM) in an attempt to diminish these adverse events. METHODS: This retrospective study describes 66 consecutive patients between the ages of 3 and 12 years who had undergone primary VNS implantation. The study population consisted of two cohorts, one in which the VNS device was implanted according to the standard described technique and a second group in which IONM was used as an adjuvant during the VNS device placement. Prior to VNS insertion, a Pediatric Voice Handicap Index (PVHI) was performed to assess voice-related quality of life, and this was repeated at 3 months following VNS insertion. RESULTS: Sixty-six patients underwent the VNS implantation. Forty-three patients had a "standard" VNS insertion technique performed, whereas 23 had IONM performed during the VNS implantation. There were significant changes in the PVHI scores across both cohorts at 3-month follow-up. There were no statistically significant differences in PVHI scores between the monitored group and non-monitored group at 3-month follow up. CONCLUSIONS: IONM can be used during VNS insertions to ensure correct placement of the leads on CNX. IONM may minimise vocal cord stimulation by placing the lead coils on the area of nerve eliciting the least amount of vocal cord EMG response. IONM however does not appear to improve voice outcomes at early follow up.
PURPOSE: The treatment of refractory epilepsy by vagus nerve stimulation (VNS) is a well-established therapy. Complications following VNS insertion may be procedure-related or stimulation-related. Herein, we describe our technique of intra-operative neuro-monitoring (IONM) in an attempt to diminish these adverse events. METHODS: This retrospective study describes 66 consecutive patients between the ages of 3 and 12 years who had undergone primary VNS implantation. The study population consisted of two cohorts, one in which the VNS device was implanted according to the standard described technique and a second group in which IONM was used as an adjuvant during the VNS device placement. Prior to VNS insertion, a Pediatric Voice Handicap Index (PVHI) was performed to assess voice-related quality of life, and this was repeated at 3 months following VNS insertion. RESULTS: Sixty-six patients underwent the VNS implantation. Forty-three patients had a "standard" VNS insertion technique performed, whereas 23 had IONM performed during the VNS implantation. There were significant changes in the PVHI scores across both cohorts at 3-month follow-up. There were no statistically significant differences in PVHI scores between the monitored group and non-monitored group at 3-month follow up. CONCLUSIONS: IONM can be used during VNS insertions to ensure correct placement of the leads on CNX. IONM may minimise vocal cord stimulation by placing the lead coils on the area of nerve eliciting the least amount of vocal cord EMG response. IONM however does not appear to improve voice outcomes at early follow up.
Authors: Karen B Zur; Stephanie Cotton; Lisa Kelchner; Susan Baker; Barbara Weinrich; Linda Lee Journal: Int J Pediatr Otorhinolaryngol Date: 2006-10-13 Impact factor: 1.675
Authors: Robert E Elliott; Amr Morsi; Stephen P Kalhorn; Joshua Marcus; Jonathan Sellin; Matthew Kang; Alyson Silverberg; Edwin Rivera; Eric Geller; Chad Carlson; Orrin Devinsky; Werner K Doyle Journal: Epilepsy Behav Date: 2010-12-08 Impact factor: 2.937