title: Treatment of epilepsy by stimulation of the vagus nerve from Head-and-Neck surgical point of view.
abstract: OBJECTIVE
  The current article is dedicated to the surgical aspect of the vagus nerve stimulation (VNS) and our efforts to improve the surgical technique. The aim was to reduce the side effect/surgical complication rate as well as the time needed for this surgery.
  
  
  METHODS
  A case series.
  
  
  METHODS
  The surgical data of 72 consecutive patients (age 4-14) who were operated for VNS device implantation from 2007 to 2014 were collected and analyzed. We designed the new surgical protocol that was implemented in all 72 cases and analyzed postsurgical side effects/complication rates. This protocol suggests low neck incision, detecting the vagus between the heads of the sternocleidomastoid muscle, a submuscular pocket for the device, and a short tunnel between it and the vagus electrodes.
  
  
  RESULTS
  The implantation took about 40 minutes; 4.2% of the patients (n = 3) were afflicted by complications related to surgery; and one patient (1.4%) suffered from hardware malfunctions. Side effects related to VNS therapy itself occurred in seven cases (6.9%).
  
  
  CONCLUSIONS
  To minimize laryngeal complications in implantation surgery for VNS devices, the surgical technique should be significantly modified, and lower neck incision could be implemented together with a submuscular pocket for the battery.
  
  
  METHODS
  4.
authors.affiliation: Department of Pediatric Surgery, Assaf Harofeh Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Lotan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Vaiman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000601:surgery / Q000628:therapy*; D006257:Head; D006801:Humans; D058542:Implantable Neurostimulators; D009333:Neck; D055536:Vagus Nerve Stimulation / Q000295:instrumentation*
keywords: Neck surgery; epilepsy; implantation surgery; vagus nerve stimulation