Associate Professor Kaiser Permanente - Oakland Oakland, CA, United States
Disclosure(s):
Elias S. Saba, MD: No relevant relationships to disclose.
Alexander Rivero, MD, FACS: No relevant relationships to disclose.
Introduction: Patients with medically refractory epilepsy who undergo vagal nerve stimulator (VNS) implantation to reduce seizure burden sometimes require removal of the device in cases such as infection. Complete explantation refers to the removal of both the generator and vagal nerve leads, and is uncommonly performed by otolaryngologists due to the perceived risk associated with lead removal. Reports regarding the safety of complete VNS explantation are limited. This comprehensive literature review and case series studies outcomes among pediatric patients undergoing complete VNS explantation.
Methods: PubMed, Embase, Web of Science, and Google Scholar were mined using a directed search strategy to identify all articles involving VNS explantation prior to January 2023. Exclusion criteria included unavailable abstract/text and irrelevance. A retrospective review of pediatric patients undergoing complete VNS explantation from 2009-2023 at our tertiary center was also conducted.
Results: The database search identified 115 articles. After screening, 36 articles were retained involving 399 patients (139 confirmed children) who underwent complete VNS explantation. 26 patients (6.5%) experienced 1+ peri/post-operative complications. These included temporary hoarseness (n=9; 2.3%), permanent vocal fold (VF) paralysis (n=6; 1.5%), temporary VF paresis (n=5; 1.3%), internal jugular vein injury (n=4; 1.0%), temporary dysphagia (n=2; 0.50%), and cable bowstring phenomenon (n=1; 0.25%).
Data from our tertiary care center revealed eight patients (6 M: 2 F) with a mean age of 11.4 ± 6.2 years. Devices were removed for clinical ineffectiveness (n=2), infection (n=2), lead failures (n=2), and increased lead impedance (n=2). Mean total length of implantation was 44.4 ± 40.3 months. Mean follow-up was 44.8 ± 35.2 months. No complications were identified.
Conclusions: Complete VNS device removal in pediatric patients is technically feasible with low reported complications. The practice of VNS surgery need not necessarily be limited to neurosurgery, and can be implemented within the scope of otolaryngology practice.
