Vagus nerve stimulation lead removal or replacement: surgical technique, institutional experience, and literature overview.
BACKGROUND
With the growing use of vagus nerve stimulation (VNS) as a treatment for refractory epilepsy, there is a growing demand for complete removal or replacement of the VNS system. We evaluate the safety and efficacy of complete removal or replacement of the VNS system and provide an extensive description of our surgical technique.


METHODS
We retrospectively reviewed our patient registry for all VNS surgeries performed between January 2007 (the year of our first complete removal) and May 2014. In order to assess patient satisfaction, a written questionnaire was sent to patients or their caregivers. Additionally, we reviewed all literature on this topic.


RESULTS
The VNS system was completely removed in 22 patients and completely replaced in 13 patients. There were no incomplete removals. Revision surgery was complicated by a small laceration of the jugular vein in two patients and by vocal cord paralysis in one patient. Seizure frequency was unaltered or improved after revision surgery. Electrode-related side effects all improved after revision surgery. Twenty-one studies reported a total of 131 patients in whom the VNS system was completely removed. In 95 patients, the system was subsequently replaced. The most frequently reported side effect was vocal cord paresis, which occurred in four patients.


CONCLUSIONS
Complete removal or replacement of the VNS system including lead and coils is feasible and safe. Although initial results seem promising, further research and longer follow-up are needed to assess whether lead replacement may affect VNS effectiveness.
Department of Neurosurgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
Marlien W
MW
Aalbers
Department of Neurosurgery, Atrium-Orbis Heerlen, PO Box 4446, 6401 CX, Heerlen, The Netherlands.
Kim
K
Rijkers
Department of Neurology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Sylvia
S
Klinkenberg
Department of Neurology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.|Epilepsy Center Kempenhaeghe, PO Box 61, 5590 AB, Heeze, The Netherlands.
Marian
M
Majoie
Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. e.cornips@mumc.nl.
Erwin M J
EM
Cornips
D000293:Adolescent; D000328:Adult; D002648:Child; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D055536:Vagus Nerve Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*
Epilepsy; Lead; Neuromodulation; Revision; Vagus nerve stimulation