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Histopathological changes in tissues surrounding vagal nerve stimulation generators: A retrospective analysis of revision surgeries

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Abstract

Purpose

Vagal nerve stimulation (VNS) is an effective treatment for patients with epilepsy, depression, and other neuropsychiatric conditions. Understanding the tissue changes associated with VNS devices is crucial for optimizing patient outcomes and device development. This study aimed to investigate the histopathological changes in the tissues surrounding the VNS generator and explore potential correlations with clinical factors and battery performance.

Methods

A total of 23 patients who underwent VNS generator revision surgery owing to battery depletion were included. Tissue samples from the areas surrounding the VNS generator were obtained and analyzed for histopathological changes. Demographic and device-related variables were also recorded.

Results

Capsule formation was observed in all patients. Acute inflammation were not detected in any case. Perivascular lymphocytic infiltration, foreign-body giant cell reaction (FBGCR), and calcification were observed in 8.7%, 26.1%, and 43.5% of patients, respectively. Crystalloid foreign body appearance was noted in 4 patients. The median output current of the generator was higher in patients with lymphocytic infiltration than in those without lymphocytic infiltration. The median off time was higher in patients with skin retraction than in those without skin retraction. Moreover, discomfort was associated with the presence of FBGCR.

Conclusion

Our study provides insights into the tissue changes associated with the VNS generator, with capsule formation being a common response. Crystalloid foreign body appearance was not reported previously. Further research is needed to understand the relationship between these tissue changes and VNS device performance, including the potential impact on battery life. These findings may contribute to VNS therapy optimization and device development.

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Data Availability

Data of our study is available to researchers upon request.

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Acknowledgements

Preparation for publication of this article is partly supported by the Turkish Neurosurgical Society.

The authors thank Mehmet KARADAĞ for his assistance with the statistical analysis in this study.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Health Sciences, Hamidiye School of Medicine, Istanbul, Turkey

    Cezmi Çağri Türk, Kerem Yilmaz & Oktay Elter

  2. Antalya Education and Research Hospital, Neurosurgery Clinic, Antalya, Turkey

    Cezmi Çağri Türk, Umut Ogün Mutlucan, Erdal Gür, Kerem Yilmaz & Oktay Elter

  3. Department of Pathology, University of Health Sciences, Hamidiye School of Medicine, Istanbul, Turkey

    Ceren Topsoy & Dinç Süren

  4. Department of Neurology, University of Health Sciences, Hamidiye School of Medicine, Istanbul, Turkey

    Fatma Genç

Authors
  1. Cezmi Çağri Türk
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Corresponding author

Correspondence to Cezmi Çağri Türk.

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Ethical approval

This study was approved by our institutional review board (IRB: 2022/14/5) and conducted in accordance with its ethical guidelines and with the tenets of the 2013 revision of the Declaration of Helsinki.

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Informed consent for participation and publication was obtained from all patients.

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Türk, C.Ç., Topsoy, C., Mutlucan, U.O. et al. Histopathological changes in tissues surrounding vagal nerve stimulation generators: A retrospective analysis of revision surgeries. Acta Neurochir 165, 2171–2178 (2023). https://doi.org/10.1007/s00701-023-05701-8

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  • DOI: https://doi.org/10.1007/s00701-023-05701-8

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