title: Vagus Nerve Stimulation Removal or Replacement Involving the Lead and the Electrode: Surgical Technique, Institutional Experience and Outcome.
abstract: OBJECTIVE
  To analyze the outcome of epileptic patients who had redo surgery involving the vagus nerve stimulation's lead.
  
  
  METHODS
  We reviewed the clinical and surgical records of all patients who had a complete vagus nerve stimulation (VNS) removal or replacement or any redo surgical procedure involving the system lead at Sainte-Anne Hospital in Paris, France.
  
  
  RESULTS
  Between the years 1999 and 2016, 41 redo surgical procedures involving the lead or electrode were achieved, of which 23 were complete VNS explantations, 12 were complete system replacements, 5 were lead changes only, and 1 was isolated lead removal. 41% of the surgical procedures were achieved in female patients. This population has a median age at VNS implantation of 33.6 years (interquartile range [IQR], [21.4-38.6]. Median time between the VNS implantation and the redo surgery involving the lead was 4.9 years (IQR, 2.9-8). The reason for VNS removal was mainly a lack of clinical effectiveness. No preoperative or postoperative complications occurred after complete VNS system removal or lead replacement. The effectiveness of the VNS therapy remained unchanged after lead replacement. No vagus nerve injury was reported, nor did symptoms suggest that it was disabled.
  
  
  CONCLUSIONS
  Complete removal or replacement of the VNS system including the lead and the electrode is feasible and safe. These procedures should be offered to patients who would no longer benefit from the VNS or when only a lead change is needed.
authors.affiliation: Department of Neurosurgery, Sainte-Anne Hospital, Paris, France. Electronic address: Charles.Champeaux@gmail.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Champeaux
authors.affiliation: Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Landré
authors.affiliation: Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.
authors.forename: Francine
authors.initials: F
authors.lastname: Chassoux
authors.affiliation: Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.
authors.forename: Michael Wilhelm
authors.initials: MW
authors.lastname: Mann
authors.affiliation: Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Devaux
authors.affiliation: Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.
authors.forename: Baris
authors.initials: B
authors.lastname: Turak
mesh_terms: D000328:Adult; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis / Q000517:prevention & control* / Q000601:surgery; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D008297:Male; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000601:surgery*
keywords: Intractable epilepsy; Lead; Neuromodulation; Replacement; Revision; Vagus nerve stimulation