Child's Nervous System

, Volume 20, Issue 5, pp 309–312 | Cite as

Left-sided vagus nerve stimulation decreases intracranial pressure without resultant bradycardia in the pig: a potential therapeutic modality for humans

  • R. Shane TubbsEmail author
  • John C. WellonsIII
  • Jeffrey P. Blount
  • W. Jerry Oakes
Original Paper



The medical literature is lacking in data regarding intracranial pressure in an animal model with concomitant vagus nerve and spinal cord stimulation.


Ten pigs were anesthetized and placed in the supine position and an intracranial pressure monitor was inserted. Each study animal had a small laminectomy performed in the lumbar region and the left vagus nerve exposed within the carotid sheath. Intracranial pressure was monitored for 3 h in all animals. Eight animals at the end of 3 h of monitoring underwent vagus nerve stimulation and or spinal cord stimulation. Study and control animals had their intracranial pressure monitored for an additional 1 and 2 h respectively.


Following vagus nerve stimulation, all animals had significant (p<0.05) decreases in their intracranial pressure with a lasting effect of 15–35 min (mean 18.5 min). No significant change in blood pressure was noted during stimulation of the vagus nerve. After spinal cord stimulation all animals responded with acute increases in their intracranial pressure (p<0.05).


Left vagus nerve stimulation reliably decreases intracranial pressure in the pig. The mechanism of this action remains unclear and does not appear to be due to resultant bradycardia. Conversely, stimulation of the upper lumbar spinal cord increases intracranial pressure with simultaneous increases in heart rate. Following additional studies and with close observation of cerebral perfusion pressure, we believe that left vagus nerve stimulation may represent a novel adjunctive therapy for decreasing elevated intracranial pressure in posttraumatic human patients with head injuries. Additionally, according to this animal data, minimizing spinal cord stimulation should be considered in the acute setting following head injury so as to minimize iatrogenic elevation of intracranial pressure.


Peripheral nerve Trauma Head injury 


  1. 1.
    Bakay RAE (1996) Vagus nerve stimulation activates central nervous system structures in epileptic patients during PET H2O blood flow imaging [comment]. Neurosurgery 39:430–431Google Scholar
  2. 2.
    Ebel H, Semmelmann G, Friese M et al (2001) Effects of electrical stimulation of the Gasserian ganglion on regional cerebral blood flow after induced subarachnoid hemorrhage in pigs evaluated by 99mTc-HMPAO-SPECT. Minim Invasive Neurosurg 44:50–57CrossRefPubMedGoogle Scholar
  3. 3.
    Garnett ES, Nahmias C, Scheffel A et al (1992) Regional cerebral blood flow in man manipulated by direct vagal stimulation. Pacing Clin Electrophysiol 15:1579–1580PubMedGoogle Scholar
  4. 4.
    Hagl C, Khaladj N, Weisz DJ et al (2002) Impact of high intracranial pressure on neurophysiological recovery and behavior in a chronic porcine model of hypothermic circulatory arrest. Eur J Cardiothorac Surg 22:510–516CrossRefPubMedGoogle Scholar
  5. 5.
    Hammond EJ, Uthman BM, Reid SA et al (1992) Electrophysiological studies of cervical vagus nerve stimulation in humans: I-EEG effects. Epilepsia 33:1013–1020PubMedGoogle Scholar
  6. 6.
    Hammond EJ, Uthman BM, Reid SA (1992) Neurochemical effects of vagus nerve stimulation in humans. Brain Res 583:300–303PubMedGoogle Scholar
  7. 7.
    Handforth A, DeGirogio CM, Schachter SC et al (1998) Vagus nerve stimulation for partial-onset seizures: a randomized active-control trial. Neurology 51:48–55PubMedGoogle Scholar
  8. 8.
    Henry TR, Bakay RAE, Votaw JR et al (1997) Acute vagus nerve stimulation selectively alters blood flow in somatosensory and limbic cortex and the cerebellum of patients with complex partial seizures [abstract]. Epilepsia 38 [Suppl 8]:144Google Scholar
  9. 9.
    Josephs LG, Est-McDonald JR, Birkett DH et al (1994) Diagnostic laparoscopy increases intracranial pressure. J Trauma 36:815–818PubMedGoogle Scholar
  10. 10.
    Kamath MV, Upton ARM, Talalla A et al (1992) Neurocardiac responses to vagoafferent electrostimulation in humans. Pacing Clin Electrophysiol 15:1581–1587PubMedGoogle Scholar
  11. 11.
    Lockard JS, Congdon WC, DuCharme LL (1990) Feasibility and safety of vagal stimulation in monkey model. Epilepsia 31:S20–S26PubMedGoogle Scholar
  12. 12.
    Meyer G, Winter DL (1970) Spinal cord participation in the Cushing reflex in the dog. J Neurosurg 33:662–675PubMedGoogle Scholar
  13. 13.
    McLachlan RS (1993) Suppression of interictal spikes and seizures by stimulation of the vagus nerve. Epilepsia 34:918–923PubMedGoogle Scholar
  14. 14.
    Naritoku DK, Morales A, Pencek TL et al (1992) Chronic vagus nerve stimulation increases the latency of the thalamocortical somatosensory evoked potential. Pacing Clin Electrophysiol 15:1572–1578PubMedGoogle Scholar
  15. 15.
    NIH Consensus Conference (1990) Surgery for epilepsy. JAMA 264:729–733PubMedGoogle Scholar
  16. 16.
    Penry JK, Dean JC (1990) Prevention of intractable partial seizures by intermittent vagal stimulation in humans: preliminary results. Epilepsia 31:40–43Google Scholar
  17. 17.
    Pettorossi VE, DiRocco C, Caldarelli M et al (1978) Influences of phasic changes in systemic blood pressure on intracranial pressure. Eur Neurol 17:216–225PubMedGoogle Scholar
  18. 18.
    Raksin PB, Alperin N, Sivaramakrishnan A et al (2003) Noninvasive intracranial compliance and pressure based on dynamic magnetic resonance imaging of blood flow and cerebrospinal fluid flow: review of principles, implementation, and other noninvasive approaches. Neurosurg Focus 14:1–8Google Scholar
  19. 19.
    Rutecki P (1990) Anatomical, physiological, and theoretical basis for the antiepileptic effect of vagus nerve stimulation. Epilepsia 31:S1–S6Google Scholar
  20. 20.
    Salinsky MC, Burchiel KJ (1993) Vagus nerve stimulation has no effect on awake EEG rhythms in humans. Epilepsia 34:299–304PubMedGoogle Scholar
  21. 21.
    Upton ARM (1992) Editorial. Pacing Clin Electrophysiol 15:1543–1544Google Scholar
  22. 22.
    Wallis DE, Littman WJ, Scanlon PJ et al (1987) The effects of elevated intracranial pressure on the canine electrocardiogram. J Electrocardiol 20:154–161PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • R. Shane Tubbs
    • 1
    • 2
    Email author
  • John C. WellonsIII
    • 2
  • Jeffrey P. Blount
    • 2
  • W. Jerry Oakes
    • 2
  1. 1.Department of Cell BiologyUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Pediatric NeurosurgeryChildren’s HospitalBirminghamUSA

Personalised recommendations