Smyth Matthew D, Tubbs R Shane, Bebin E Martina, Grabb Paul A, Blount Jeffrey P
Pediatric Neurosurgery, Children's Hospital of Alabama, Alabama, USA.
J Neurosurg. 2003 Sep;99(3):500-3. doi: 10.3171/jns.2003.99.3.0500.
The aim of this study was to define better the incidence of surgical complications and untoward side effects of chronic vagus nerve stimulation (VNS) in a population of children with medically refractory epilepsy.
The authors retrospectively reviewed the cases of 74 consecutive patients (41 male and 33 female) 18 years of age or younger (mean age 8.8 years, range 11 months-18 years) who had undergone implantation of a vagal stimulator between 1998 and 2001 with a minimum follow up of 1 year (mean 2.2 years). Of the 74 patients treated, seven (9.4%) had a complication ultimately resulting in removal of the stimulator. The rate of deep infections necessitating device removal was 3.5% (three of 74 patients who had undergone 85 implantation and/or revision procedures). An additional three superficial infections occurred in patients in whom the stimulators were not removed: one was treated with superficial operative debridement and antibiotic agents and the other two with oral antibiotics only. Another four stimulators (5.4%) were removed because of the absence of clinical benefit and device intolerance. Two devices were revised because of lead fracture (2.7%). Among the cohort, 11 battery changes have been performed thus far, although none less than 33 months after initial implantation. Several patients experienced stimulation-induced symptoms (hoarseness, cough, drooling, outbursts of laughter, shoulder abduction, dysphagia, or urinary retention) that did not require device removal. Ipsilateral vocal cord paralysis was identified in one patient. One patient died of aspiration pneumonia more than 30 days after device implantation.
Vagus nerve stimulation remains a viable option for improving seizure control in difficult to treat pediatric patients with epilepsy. Surgical complications such as hardware failure (2.7%) or deep infection (3.5%) occurred, resulting in device removal or revision. Occasional stimulation-induced symptoms such as hoarseness, dysphagia, or torticollis may be expected (5.4%).
本研究旨在更明确地界定慢性迷走神经刺激（VNS）在药物难治性癫痫儿童群体中的手术并发症发生率及不良副作用。
作者回顾性分析了1998年至2001年间连续接受迷走神经刺激器植入的74例18岁及以下患者（41例男性，33例女性）的病例，最小随访时间为1年（平均2.2年）。在接受治疗的74例患者中，7例（9.4%）出现并发症，最终导致刺激器移除。因深部感染需要移除装置的发生率为3.5%（74例接受85次植入和/或翻修手术的患者中有3例）。另外3例患者出现浅表感染，但刺激器未被移除：1例接受了浅表手术清创和抗生素治疗，另外2例仅接受口服抗生素治疗。另有4例刺激器（5.4%）因无临床益处和装置不耐受而被移除。2例装置因导线断裂而进行了翻修（2.7%）。在该队列中，迄今为止已进行了11次电池更换，不过均在首次植入后不少于33个月时进行。数名患者出现刺激诱发的症状（声音嘶哑、咳嗽、流涎、大笑发作、肩部外展、吞咽困难或尿潴留），但无需移除装置。1例患者被诊断为同侧声带麻痹。1例患者在装置植入30多天后死于吸入性肺炎。
迷走神经刺激仍然是改善难治性癫痫儿童患者癫痫控制的一种可行选择。出现了诸如硬件故障（2.7%）或深部感染（3.5%）等手术并发症，导致装置移除或翻修。可能会出现偶尔的刺激诱发症状，如声音嘶哑、吞咽困难或斜颈（5.4%）。
