Treatment of epilepsy by stimulation of the vagus nerve from Head-and-Neck surgical point of view

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Treatment of epilepsy by stimulation of the vagus nerve from Head-and-Neck surgical point of view

Source: Laryngoscope. 2014 Nov 28. doi: 10.1002/lary.25064.
Authors: Lotan, G. & Vaiman, M.

Purpose:

to report on a new implantation technique for VNS device designed in order to reduce side effects and complications of VNS surgery.

Methods:

the technique differs from the usual technique because the neck incision is lower and the battery is placed in the axilla.

Results:

72 patients were operated following this new protocol. Complications related to surgery were found in three patients: two got a granuloma around the nonabsorbable stitches and one patient got a seroma. Side effects related to VNS therapy were found in seven patients: three had hoarseness, two had periodec hiccups and one had dyspnea. The implantation took about 40 min.

Conclusion:

the application of this newly designed technique considerably reduces frequency of side effects.

http://www.ncbi.nlm.nih.gov/pubmed/25429912

Comments reviewer, prof Van Nieuwenhuizen:

as the authors stated application of this technique provides the following advantages:

 

  • Choosing for a lower neck incision makes it possible to avoid damage to major veins and no lymph nodes are located in the carotid sheath.
  • The distance between the two incisions is shorter: the operating time is short (40 min.).
  • The location of the electrodes is well distanced from the larynx and the cardiac branches of the vagus nerve, as well as from the origin of the recurrent aryngeal nerve, which minimizes the rate of side effects such as bradycardia, cough, and hoarseness (4.2% of the patients 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%).
  • The operation scars are hardly visible as is the bulge of the battery.
  • The battery is protected by the muscle from accidental impacts (in particular important for mentally and/or behaviourally handicapped patients).

It is hardly imaginable that so few studies have been carried out and published with regards to operation technique of VNS Therapy. The authors stand up for a lower neck incision and axillar implantation. Their arguments make sense. However, it’s one study in one centre. It would be interesting and necessary to see whether their results can be reproduced in an open, randomized controlled trial.

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