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Vagus nerve stimulator revision in pediatric epilepsy patients: a technical note and case series

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Abstract

Introduction

Vagus nerve stimulation (VNS) is an adjunctive treatment in children with intractable epilepsy. When lead replacement becomes necessary, the old leads are often truncated and retained and new leads are implanted at a newly exposed segment of the nerve. Direct lead removal and replacement are infrequently described, with outcomes poorly characterized. We aimed to describe our experience with feasibility of VNS lead removal and replacement in pediatric patients.

Methods

Retrospective review examined 14 patients, at a single, tertiary-care, children’s hospital, who underwent surgery to replace VNS leads, with complete removal of the existing lead from the vagus nerve and placement of a new lead on the same segment of the vagus nerve, via blunt and sharp dissection without use of electrocautery. Preoperative characteristics, stimulation parameters, and outcomes were collected.

Results

Mean age at initial VNS placement was 7.6 years (SD 3.5, range 4.5–13.4). Most common etiologies of epilepsy were genetic (5, 36%) and cryptogenic (4, 29%). Lead replacement was performed at a mean of 6.0 years (SD 3.8, range 2.1–11.7) following initial VNS placement. Reasons for revision included VNS lead breakage or malfunction. There were no perioperative complications, including surgical site infection, voice changes, dysphagia, or new deficits postoperatively. Stimulation parameters after replacement surgery at last follow-up were similar compared to preoperatively, with final stimulation parameters ranging from 0.25 mA higher to 1.5 mA lower to maintain baseline seizure control. The mean length of follow-up was 7.9 years (SD 3.5, range 3.1–13.7).

Conclusion

Removal and replacement of VNS leads are feasible and can be safely performed in children. Further characterization of surgical technique, associated risk, impact on stimulation parameters, and long-term outcomes are needed to inform best practices in VNS revision.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Texas Children’s Hospital; Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA

    Melissa A. LoPresti, Daniel J. Curry & Howard L. Weiner

  2. Division of Pediatric Neurosurgery, Lurie Children’s Hospital; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Melissa A. LoPresti, Jonathan Huang, Nathan A. Shlobin & Sandi K. Lam

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  1. Melissa A. LoPresti
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Contributions

ML developed the concept, completed data collection, drafted the manuscript, and critically revised the manuscript. JH and NS completed Tables 1 and 2 and drafted the manuscript. DC and HL provided support and mentorship and critically revised the manuscript. SL developed the concept, completed data collection, completed Fig. 1, provided support and mentorship, and critically revised the manuscript. All authors reviewed the manuscript.

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Correspondence to Sandi K. Lam.

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LoPresti, M.A., Huang, J., Shlobin, N.A. et al. Vagus nerve stimulator revision in pediatric epilepsy patients: a technical note and case series. Childs Nerv Syst 39, 435–441 (2023). https://doi.org/10.1007/s00381-022-05769-0

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