Razmara Ashkaun, Idlett-Ali Shaquia, Chee Keanu, Shrestha Keshari, Bayman Eric, Thompson John, Jameson Leslie, Ojemann Steven, Kramer Daniel
Department of Neurosurgery, University of Colorado School of Medicine, Aurora, United States.
Department of Anesthesiology, University of Colorado School of Medicine, Aurora, United States.
Surg Neurol Int. 2022 Apr 8;13:131. doi: 10.25259/SNI_21_2022. eCollection 2022.
Vagal nerve stimulation (VNS) is a Food and Drug Administration approved therapy for seizures with a suggested mechanism of action consisting of cortical desynchronization, facilitated through broad release of inhibitory neurotransmitters in the cortex and brainstem. The vagus nerve contains visceral afferents that transmit sensory signals centrally, from locations that include the heart and the aorta. Although the vagus nerve serves a role in cardiac function, electrical stimulation with VNS has rarely resulted in adverse cardiac events. Here, we report a case of a cardiac event during left-sided VNS implantation.
A 22-year-old male with an 8-year history of absence seizures and a 3-year history of medically refractory generalized tonic-clonic seizure was planned for surgical implantation of a VNS device. In the operating room, the patient underwent left-sided VNS implantation. An initial impedance check was performed with subsequent wound irrigation; following a few seconds of irrigation, a 5 s complete cardiac pause was noted. A repeated impedance check, which included turning on the stimulation, did not replicate the cardiac pause. No further pauses or cardiac events were noted and the case continued to completion without issue. The patient was later activated without any further complications.
This report describes the initiation of a cardiac event, unlikely resulting from VNS, but instead time linked to intraoperative irrigation directly on the vagus nerve.
迷走神经刺激（VNS）是一种经美国食品药品监督管理局批准用于治疗癫痫的疗法，其作用机制被认为是通过在皮质和脑干广泛释放抑制性神经递质来促进皮质去同步化。迷走神经包含内脏传入神经，可将来自包括心脏和主动脉等部位的感觉信号向中枢传导。尽管迷走神经在心脏功能中发挥作用，但VNS电刺激很少导致不良心脏事件。在此，我们报告一例在左侧VNS植入过程中发生的心脏事件。
一名22岁男性，有8年失神发作病史和3年药物难治性全身强直阵挛发作病史，计划接受VNS装置的手术植入。在手术室中，患者接受了左侧VNS植入。首先进行了阻抗检查，随后进行伤口冲洗；冲洗几秒钟后，记录到5秒的完全心脏停搏。包括开启刺激在内的重复阻抗检查未再现心脏停搏。未再观察到进一步的停搏或心脏事件，该病例顺利完成。患者后来被激活，未出现任何进一步的并发症。
本报告描述了一次心脏事件的发生，不太可能由VNS引起，而是与术中直接对迷走神经进行冲洗的时间相关。
