儿童和青年患者经胸锁乳突肌下入路行迷走神经刺激器的美学放置：一项技术说明。

Aesthetic transaxillary subpectoral placement of vagus nerve stimulator in children and young adults: A technical note.

机构信息

Pediatric and Functional Neurosurgery Unit, Department of Neuroscience, Padua University Hospital, Italy.

Pediatric Surgery Unit, Department of Women's and Children's Health, Padua University Hospital, Italy.

出版信息

Epilepsy Behav. 2023 Oct;147:109419. doi: 10.1016/j.yebeh.2023.109419. Epub 2023 Sep 5.

DOI:10.1016/j.yebeh.2023.109419

PMID:37677901

Abstract

INTRODUCTION

Vagus nerve stimulation (VNS) is a neuromodulation therapy for drug-resistant epilepsy (DRE), refractory status epilepticus, and treatment-resistant depression. The lead is tunneled into the subcutaneous space and connected to the generator, which is usually implanted in a subcutaneous pocket below the clavicle. Surgical complications in the chest region include skin breakdown or infection. An alternative approach is to perform a subclavear subpectoral implantation. In our surgical series, we report a new aesthetic implantation method for VNS generators in children and young patients: the transaxillary subpectoral placement.

MATERIALS AND METHODS

From May 2021 to May 2023, 10 vagus nerve stimulation generators were placed subpectorally with a transaxillary approach by the authors. We considered operative time, surgical complications such as blood loss, infections, device migration, pain, and adverse events at follow-up.

RESULTS

In this surgical series, we reviewed all cases of subpectoral implantation of VNS generators in children and young adults at our institution in the last 2 years. All patients were treated with subpectoral Sentiva 1000 (Livanova PLC) insertion with axillary access by a neurosurgeon and a pediatric surgeon. The operative time was slightly longer compared to the traditional subcutaneous implant. All generators reported impedances within the optimal range. Blood loss was not significant and no other perioperative complications were reported. Patients and families were highly satisfied with the outcomes in terms of comfort and aesthetic results after surgery and at the last follow-up. No cases of infection occurred, and no malfunctions or displacements of the generator were registered at clinical follow-up.

CONCLUSION

The transaxillary subpectoral placement of theVNS generator is an aesthetic and anatomic approach, which provides several benefits to children and young adults.

摘要

简介

迷走神经刺激（VNS）是一种用于治疗耐药性癫痫（DRE）、难治性癫痫持续状态和治疗抵抗性抑郁症的神经调节疗法。导线被隧道到皮下空间并连接到发生器，发生器通常植入锁骨下的皮下袋中。胸部区域的手术并发症包括皮肤破裂或感染。一种替代方法是进行锁骨下胸肌下植入。在我们的手术系列中，我们报告了一种用于儿童和年轻患者的 VNS 发生器的新美学植入方法：经腋窝胸肌下放置。

材料和方法

从 2021 年 5 月至 2023 年 5 月，作者通过经腋窝途径对 10 例迷走神经刺激发生器进行了胸肌下放置。我们考虑了手术时间、手术并发症（如失血、感染、设备迁移、疼痛和随访时的不良事件）。

结果

在这个手术系列中，我们回顾了过去 2 年在我们机构中所有儿童和年轻成人的 VNS 发生器的胸肌下植入病例。所有患者均由神经外科医生和小儿外科医生通过腋窝入路接受胸肌下 Sentiva 1000（Livanova PLC）植入。与传统的皮下植入相比，手术时间稍长。所有发生器的阻抗均在最佳范围内。失血量不大，无其他围手术期并发症。患者和家属对手术后和最后一次随访时的舒适度和美学效果非常满意。在临床随访中未发生感染病例，也未发现发生器故障或移位。