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VNS implantation in a NF1 patient: massive nerve hypertrophy discovered intra-operatively preventing successful electrode placement. Case report

  • Case Report - Functional Neurosurgery - Epilepsy
  • Published:
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Abstract

For the vast majority of surgeons, no specific investigation is necessary before vagal nerve stimulation (VNS) implantation. We report our intraoperative unexpected finding of a massively enlarged vagus nerve in a patient with neurofibromatosis type 1 (NF1). The nerve hypertrophy prevented wrapping the coils of the helical electrode. The patient had no signs of vagus nerve dysfunction preoperatively (no hoarseness or dysphonia). This exceptional mishap is undoubtedly related to NF1-associated peripheral nerve sheath tumors. Even though it is not advisable to routinely perform any imaging prior to VNS, in such specific context, preoperative imaging work-up, especially cervical ultrasound, might be judicious to rule out any asymptomatic enlarged left vagus nerve.

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Author information

Authors and Affiliations

  1. Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Aix Marseille University, Marseille, France

    Hussein Hamdi, Yassine Beltaifa & Romain Carron

  2. APHM, INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France

    Hussein Hamdi & Romain Carron

  3. Functional Neurosurgery and Stereotaxy Unit, Neurological Surgery Department, Tanta University, Tanta, Egypt

    Hussein Hamdi

  4. Department of Neuroradiology, Timone University Hospital, Aix Marseille University, Marseille, France

    Gilles Brun

  5. Department of Neurosurgery, Sainte-Anne Hospital, Paris Descartes University, Sorbonne Paris Cité, Paris, France

    Marc Zanello

  6. Department of Neurosurgery, Heinrich Heine University, Düsseldorf, Germany

    Maxine Dibué

  7. Epileptology Department, Timone Hospital, APHM, INSERM, INS, Inst Neurosci Syst, Aix Marseille University, Marseille, France

    Stanislas Lagarde, Agnes Trébuchon & Fabrice Bartolomei

Authors
  1. Hussein Hamdi
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  2. Gilles Brun
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  3. Marc Zanello
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  4. Maxine Dibué
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  5. Yassine Beltaifa
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  6. Stanislas Lagarde
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  7. Agnes Trébuchon
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  8. Fabrice Bartolomei
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  9. Romain Carron
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Correspondence to Romain Carron.

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Disclosure

R.C. received honoraria from Cyberonics/Livanova for sharing expertise about VNS surgery during symposium. Other authors have no relevant disclosure. M.D. is an employee of LivaNova PLC and holds stock options.

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This article is part of the Topical Collection on Functional Neurosurgery - Epilepsy

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Hamdi, H., Brun, G., Zanello, M. et al. VNS implantation in a NF1 patient: massive nerve hypertrophy discovered intra-operatively preventing successful electrode placement. Case report. Acta Neurochir 162, 2509–2512 (2020). https://doi.org/10.1007/s00701-020-04535-y

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  • DOI: https://doi.org/10.1007/s00701-020-04535-y

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