title: Revision of vagal nerve stimulator electrodes through a posterior cervical triangle approach: technical note.
abstract: BACKGROUND
  We describe an approach to vagal nerve stimulator (VNS) lead replacement through the posterior cervical triangle. Scar around the structures of the carotid sheath is avoided and new leads are placed on a pristine section of the vagus nerve proximal to the original site.
  
  
  METHODS
  Skin incision from the implantation surgery is incorporated and extended to allow access to the posterior border of the sternocleidomastoid muscle (SCM). Dissection proceeds along the posterior border of the SCM. The SCM and jugular vein are retracted anterior to expose a fresh segment of the vagal nerve immediately superficial to the carotid artery and proximal to the original electrode site. Once the nerve is adequately exposed, electrode placement proceeds in the standard fashion. Dysfunctional electrodes are left in place, and the lead wire is cut as near the electrodes as can be easily accessed. Three patients have undergone lead revision with this approach. Lead placement was successful and free from complications in all cases.
  
  
  CONCLUSIONS
  The posterior cervical triangle approach provides a virgin dissection plane for VNS revision.
authors.affiliation: Division of Pediatric Neurosurgery, The Children's Hospital, University of Colorado, Aurora, Colorado, USA. Boneill35@gmail.com
authors.forename: Brent R
authors.initials: BR
authors.lastname: O'Neill
authors.forename: James E
authors.initials: JE
authors.lastname: Wilberger
mesh_terms: D000328:Adult; D004567:Electrodes, Implanted / Q000009:adverse effects* / Q000592:standards; D005548:Foreign-Body Migration / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D009333:Neck / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods*; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D055536:Vagus Nerve Stimulation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods