Gigliotti Michael J, Mao Gordon, Dupré Derrick A, Wilberger Jack
Allegheny General Hospital, Department of Neurosurgery, Pittsburgh, Pennsylvania, USA.
Allegheny General Hospital, Department of Neurosurgery, Pittsburgh, Pennsylvania, USA.
World Neurosurg. 2018 Dec;120:e1047-e1053. doi: 10.1016/j.wneu.2018.09.008. Epub 2018 Sep 11.
The goal of this study was to assess the indications of revision for vagal nerve stimulation at a single institution in an adult population with drug-resistant epilepsy.
This was a retrospective review of a prospectively collected database who underwent vagal nerve stimulator implantation for drug-resistant epilepsy during 1992-2017. Patients receiving vagal nerve stimulation (VNS) implants were monitored throughout their perioperative and postoperative course and were classified according to type of seizure at the time of diagnosis and indications for VNS revision. In addition, response to dysfunctional VNS devices or adverse effects were noted.
Most patients receiving VNS implants were given a diagnosis of complex partial seizures (CPSs) before implantation (95.1%). Other epileptic conditions identified requiring implantation included generalized seizures, generalized-atonic seizures, Lennox-Gastaut syndrome, CPS or generalized seizures, and tuberous sclerosis (with generalized characteristics). High lead impedance was the most common indication for revision (5.6%), whereas device ineffectiveness leading to continued seizures was the most common indication for removal (2.3%). Infection, lead fracture, and dual- to single-pin lead battery changes occurred at an incidence of 1.9%, requiring either implant removal or revision. Other events that occurred, albeit rarely, included skin extrusion (0.5%), postoperative hematoma (0.5%), and implant rejection (0.5%) necessitating removal.
VNS implantation in adults was shown to be a well-tolerated procedure. In addition, indications for revision or removal of the VNS device was low in this population with lead fracture rates lower than the incidence reported in pediatric population literature.
本研究的目的是评估在一家机构中，对成年耐药性癫痫患者进行迷走神经刺激术翻修的指征。
这是一项对1992年至2017年间因耐药性癫痫接受迷走神经刺激器植入术的前瞻性收集数据库进行的回顾性研究。接受迷走神经刺激（VNS）植入的患者在围手术期和术后全程接受监测，并根据诊断时的癫痫发作类型和VNS翻修指征进行分类。此外，记录对功能失调的VNS设备的反应或不良反应。
大多数接受VNS植入的患者在植入前被诊断为复杂部分性发作（CPS）（95.1%）。确定需要植入的其他癫痫情况包括全身性发作、全身失张力发作、Lennox-Gastaut综合征、CPS或全身性发作以及结节性硬化症（具有全身性特征）。高导联阻抗是最常见的翻修指征（5.6%），而导致持续发作的设备无效是最常见的移除指征（2.3%）。感染、导联断裂以及双引脚至单引脚电池更换的发生率为1.9%，需要移除植入物或进行翻修。其他虽罕见但发生的事件包括皮肤挤出（0.5%）、术后血肿（0.5%）和植入物排斥反应（0.5%），均需要移除。
在成人中进行VNS植入显示是一种耐受性良好的手术。此外，该人群中VNS设备翻修或移除的指征较低，导联断裂率低于儿科人群文献报道的发生率。
