Vagus nerve stimulator implantation in children.
BACKGROUND
Vagus nerve stimulation was approved in 1997 as an adjunctive treatment of partial-onset seizures refractory to medical therapy. Subsequent to the initial clinical trials, few studies have been published specifically addressing perioperative management issues.


OBJECTIVE
To review the operative technique and perioperative management of patients undergoing vagus nerve stimulator implantation and to analyze complications and their management.


METHODS
Retrospective medical record review and survey of patients who underwent implantation.


METHODS
A tertiary care pediatric hospital in Kansas City, Mo.


METHODS
One hundred two patients aged 21 months to 40 years.


METHODS
Vagus nerve stimulator implantation and lead placement.


METHODS
The surgical technique of vagus nerve stimulator implantation is presented in detail. Perioperative complications are enumerated, and strategies for their management are described. A subjective patient survey addresses some quality-of-life issues and the effect on swallowing and voice.


RESULTS
One hundred two patients successfully underwent vagus nerve stimulator implantation. Three patients experienced infection of the chest wound holding the generator and required explantation. These 3 patients underwent reimplantation within 2 months after the infection had cleared. Most patients experience some degree of hoarseness when the generator is activated, but this symptom usually does not significantly affect the ability to communicate. Responses to questions regarding quality of life are positive.


CONCLUSIONS
Vagus nerve stimulator implantation has a low incidence of serious complications. Quality of life seems to be improved for most patients. Modifications to the surgical procedure must be considered when performing the implantation on a young patient.
Kirse
Daniel J
DJ
Division of Pediatric Otolaryngology, Children's Mercy Hospitals and Clinics, Kansas City, USA.
Werle
Andreas H
AH
Murphy
Jerome V
JV
Eyen
Thomas P
TP
Bruegger
Daniel E
DE
Hornig
Gregory W
GW
Torkelson
Richard D
RD
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted; D004827:Epilepsy / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records; D008991:Monitoring, Physiologic; D017060:Patient Satisfaction; D011184:Postoperative Period; D011300:Preoperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000502:physiology*