Donahue David, Sanchez Rosa, Hernandez Angel, Malik Saleem, Black C Thomas, Honeycutt Johnnie
Cook Children's Medical Center, Fort Worth, Texas 76104, USA.
J Neurosurg. 2007 Dec;107(6 Suppl):519-20. doi: 10.3171/PED-07/12/519.
Patients with epilepsy and an implanted vagus nerve stimulation (VNS) device who are referred for consideration of definitive epilepsy surgery (removal of the epileptogenic cortex) may require magnetoencephalography (MEG), a study requiring explantation of the pulse generator, as part of their evaluation. Nonetheless, these patients may not wish to abandon palliative VNS therapy should definitive surgery prove unsuccessful or impossible. To avoid obliteration of the pocket by scar tissue after the pulse generator is explanted, the authors have preserved the dead space in several patients with insertion of a similarly sized silicone block. This block is easily replaced with the pulse generator if continued VNS therapy is appropriate, and is left in place in patients who appear to no longer require VNS therapy. Upon completion of MEG, if pulse generator replacement proves desirable, atraumatic retrieval of the electrode connector pin and body is easy. Silicone block implantation during what may prove to be temporary device explantation facilitates reuse of the original pulse generator implantation site and atraumatic distal electrode wire retrieval.
因考虑进行确定性癫痫手术（切除致痫皮层）而被转诊的植入迷走神经刺激（VNS）装置的癫痫患者，在评估过程中可能需要进行脑磁图（MEG）检查，该检查需要取出脉冲发生器，是评估的一部分。然而，如果确定性手术被证明不成功或无法进行，这些患者可能不希望放弃姑息性VNS治疗。为避免在取出脉冲发生器后瘢痕组织闭塞囊袋，作者在几名患者中通过插入尺寸相似的硅胶块保留了死腔。如果继续进行VNS治疗合适，该硅胶块可轻松用脉冲发生器替换，而在似乎不再需要VNS治疗的患者中则将其留在原位。完成MEG检查后，如果证明需要更换脉冲发生器，电极连接器插脚和主体的无创取出很容易。在可能被证明是临时取出装置期间植入硅胶块，便于重新利用原来的脉冲发生器植入部位，并无创取出远端电极导线。
