Uchida Daiki, Yamamoto Takamichi, Yamazoe Tomohiro, Iijima Kentaro, Fujimoto Ayataka, Enoki Hideo, Tanaka Tokutaro
Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital.
No Shinkei Geka. 2017 Dec;45(12):1051-1057. doi: 10.11477/mf.1436203646.
Vagus nerve stimulation(VNS)for patients with intractable epilepsy was approved by the Japan Ministry of Health, Labour and Welfare in 2010. More than 1,500 VNS systems were implanted by the end of August 2016. The aim of the present report is to describe complications we experienced at our department and consider the way to avoid them.
We retrospectively reviewed 139 consecutive patients(122 new implantations and 17 reimplantations)between December 2010 and March 2016.
Seven patients demonstrated eight complications. Four patients experienced recurrent nerve paralysis with hoarseness and/or cough that did not require device removal. One patient experienced subsequent aspiration pneumonia. The device was removed in one case due to lead fracture and in three owing to surgical site infection(SSI).
All recurrent nerve paralysis occurred just after we started VNS implantations. It was presumed that the nerve paralysis was caused by retraction around the vagus nerve. Smaller skin incision and decreased retraction of the surgical field has eliminated this complication. The incidence of infections is reported as 2.2%. Allergic reaction to the VNS device might be one of the causes for SSI in our series. Fracture of the lead was caused by revolving of the pulse generator under the skin. Tight sutures around the pocket or subpectoral placement of a pulse generator is necessary to prevent rotation of the generator depending upon the activity of each patient. This paper provides insight into complications and successful strategies for better outcomes in VNS therapy.
2010年，日本厚生劳动省批准了迷走神经刺激术（VNS）用于治疗难治性癫痫患者。截至2016年8月底，已植入了1500多个VNS系统。本报告旨在描述我们科室所经历的并发症，并探讨避免这些并发症的方法。
我们回顾性分析了2010年12月至2016年3月期间连续的139例患者（122例初次植入和17例再次植入）。
7例患者出现了8种并发症。4例患者出现反复的神经麻痹，伴有声音嘶哑和/或咳嗽，无需取出装置。1例患者随后发生吸入性肺炎。1例因导线断裂取出装置，3例因手术部位感染（SSI）取出装置。
所有反复的神经麻痹均发生在我们开始进行VNS植入术后不久。推测神经麻痹是由迷走神经周围的牵拉所致。较小的皮肤切口和减少手术视野的牵拉已消除了这种并发症。报道的感染发生率为2.2%。对VNS装置的过敏反应可能是我们系列中SSI的原因之一。导线断裂是由皮下脉冲发生器的旋转引起的。根据每个患者的活动情况，在囊袋周围紧密缝合或在胸大肌下放置脉冲发生器对于防止发生器旋转是必要的。本文深入探讨了VNS治疗中的并发症及取得更好疗效的成功策略。
