High lead impedances requiring revision during vagal nerve stimulator generator replacement
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ORIGINAL ARTICLE - FUNCTIONAL NEUROSURGERY - EPILEPSY
High lead impedances requiring revision during vagal nerve stimulator generator replacement Pouya Entezami 1
&
John W. German 1 & Matthew A. Adamo 1
Received: 5 June 2020 / Accepted: 15 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Objective Vagal nerve stimulation (VNS) therapy is among the growing options in the treatment of intractable epilepsy. The phenomenon of surprise lead impedance issues found at the time of surgery resulting in unplanned lead revision is a challenge with this type of device. We reviewed our experience with VNS revisions. Material and methods We retrospectively reviewed the records of all adult and pediatric patients between January 2009 and September 2018 who underwent surgery for VNS therapy, including revision surgery. Office and operative notes were reviewed to obtain the indications and operative details for VNS placement. Results A total of 570 operations were reviewed. The indication was intractable epilepsy in all cases. Primary implantation was performed in 232 patients, while the remaining 338 cases were revision cases of various natures. Surprise high lead impedance was found in 10 (3%) of these cases, resulting in a significantly increased complexity of surgery in those instances. Conclusion Lead impedance issues can be caused by disconnection, electrode fracture, hardware failure, or tissue scarring but ultimately require a more extended surgery than may be initially planned. Anticipating the potential for a more extensive operation than a simple generator replacement may prevent perioperative frustrations on both sides. Keywords Vagal nerve stimulation . Hardware failure . Epilepsy surgery . Implantation . Stimulation
Introduction Vagal nerve stimulation (VNS) therapy has been an option for the treatment of intractable epilepsy since the 1980s [1–3]. For patients with medically refractory seizures, intermittent stimulation of the vagal nerve has been shown to improve quality of life. Candidates include patients who are not candidates for epilepsy surgery (i.e., those without localizable seizure foci) or those who have failed operative management [4–6]. Longterm benefits have been observed with low risk of side effects and increasing efficacy with duration of treatment [7, 8]. Given that roughly 30% of those with epilepsy become refractory to medication therapy, VNS implantation is an increasingly popular option. While typically mild side effects of VNS This article is part of the Topical Collection on Functional Neurosurgery - Epilepsy * Pouya Entezami [email protected] 1
Department of Neurosurgery, Albany Medical College, 47 New Scotland Ave, MC-10, Albany, NY 12208-3479, USA
therapy include voice alterations, paresthesias, sore throat and coughing, and breathing issues, among others, these are experienced in up to 80% of patients [9, 10]. Nevertheless, these are often manageable and do not detract from the benefit of VNS implantation. Several authors have reported on the issue
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