Ng Wai Hoe, Donner Elizabeth, Go Cristina, Abou-Hamden Amal, Rutka James T
Division of Neurosurgery, Suite 1503, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada.
Childs Nerv Syst. 2010 Aug;26(8):1081-4. doi: 10.1007/s00381-010-1121-2. Epub 2010 Mar 12.
As a result of the increasingly popularity of vagal nerve stimulation (VNS) for intractable seizures, neurosurgeons not uncommonly encounter cases which require electrode revision. We examine our experience of VNS revision and reports the use of the ultra-sharp monopolar tip for safe dissection and removal of the electrode from the vagus nerve.
A retrospective review was performed from January 2000 to Dec 2009 reviewed eight cases of VNS revision.
The indications for VNS revision were device malfunction manifesting with increased seizures or increased impedance of the device and infection. The time from initial VNS implantation to revision ranged from 6 to 108 months (mean: 38 months). The entire VNS electrode system, was removed in seven cases and the helical coils were left in-situ in one case who did not derive any benefit from VNS and it was deemed unnecessary to subject the patient to the additional risk of vagal nerve injury. One case had dislodgement of the lower two coils and three cases had dense scarring to the vagus nerve causing high impedance and malfunction. The other three cases demonstrated no fibrotic scar tissue between the helical coils and the vagus nerve. Four cases had replacement of new VNS system but the case of infected VNS stimulator was not replaced as there was no benefit from the device.
VNS revision is normally performed in cases of device malfunction or infection and can be safely performed using a combination of ultra-sharp monopolar coagulation and sharp dissection.
由于迷走神经刺激术（VNS）在治疗顽固性癫痫方面越来越受欢迎，神经外科医生经常会遇到需要电极修复的病例。我们回顾了我们在VNS修复方面的经验，并报告了使用超锋利单极尖端安全地从迷走神经上分离和移除电极的情况。
对2000年1月至2009年12月期间的8例VNS修复病例进行了回顾性研究。
VNS修复的指征为设备故障，表现为癫痫发作增加或设备阻抗增加以及感染。从最初植入VNS到修复的时间为6至108个月（平均：38个月）。7例患者移除了整个VNS电极系统，1例患者的螺旋线圈留在原位，该患者未从VNS中获益，且认为让患者承受迷走神经损伤的额外风险没有必要。1例患者下两个线圈移位，3例患者迷走神经有致密瘢痕形成，导致高阻抗和故障。另外3例患者在螺旋线圈和迷走神经之间未显示纤维化瘢痕组织。4例患者更换了新的VNS系统，但感染的VNS刺激器病例未更换，因为该设备没有益处。
VNS修复通常在设备故障或感染的情况下进行，并且可以通过结合使用超锋利单极凝固和锐性分离安全地进行。
