Thakur Nikhil, Krüger Valentin, Czabanka Marcus, Quick-Weller Johanna
Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany.
Department of Neurology, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany.
Brain Spine. 2024 Dec 12;5:104155. doi: 10.1016/j.bas.2024.104155. eCollection 2025.
Breathing-synchronized hypoglossal-nerve stimulation is a treatment option for suitable patients with severe obstructive-sleep-apnoea. The classical implantation technique requires three incisions: submental to place the stimulating-electrode on terminal branches of the hypoglossal-nerve, sub-clavicular to place the impulse generator, and on the lateral chest-wall to place a breathing-sensor lead. A two-incision-technique has been propagated and widely adopted whereby the respiratory-sensing-lead is placed deeper to the IPG-pocket.
Our department switched to the 2-incision-technique in May 2021 and we set out to compare the two methods concerning the generated respiratory-sensing-curves.
Cases operated between October 2020 and September 2022 were included. Parameters included age, gender, BMI, OR time, positioning of the detection-lead, and preoperative Apnoea-Hypopnoea Index (AHI). The generated respiratory-sensing curves were categorized by an independent expert blinded to the surgical-technique regarding conduciveness to optimal stimulation.
21 patients were included. 5 were operated with the 3-incision-technique. Women were underrepresented. There were no further significant differences in patient characteristics. The expert-opinion on the respiratory-sensing-curves did not vary between groups. Mean OR-time was marginally less in the 2-incision group without being statistically significant.
The 2-incision-technique generates respiratory-sensing curves at par with those generated with 3-incision-implants. The limited patient data collected in this analysis suggests that OR-time can be reduced using the 2-incision-technique. There were no cases of postoperative complications in our cohort. It can be postulated that a 2-incision-implant has a lower risk of infection due to the reduced wound-surface.
呼吸同步舌下神经刺激是重度阻塞性睡眠呼吸暂停合适患者的一种治疗选择。传统的植入技术需要三个切口：颏下切口用于将刺激电极置于舌下神经终末分支上，锁骨下切口用于放置脉冲发生器，侧胸壁切口用于放置呼吸传感器导线。一种两切口技术已得到推广并被广泛采用，即呼吸传感导线放置在植入式脉冲发生器（IPG）囊袋更深的位置。
我们科室于2021年5月改用两切口技术，我们着手比较这两种方法所产生的呼吸传感曲线。
纳入2020年10月至2022年9月间接受手术的病例。参数包括年龄、性别、体重指数、手术时间、检测导线的位置以及术前呼吸暂停低通气指数（AHI）。由一位对手术技术不知情的独立专家对所产生的呼吸传感曲线进行分类，以评估其对最佳刺激的适宜性。
纳入21例患者。5例采用三切口技术进行手术。女性患者比例较低。患者特征方面没有其他显著差异。两组之间专家对呼吸传感曲线的意见没有差异。两切口组的平均手术时间略短，但无统计学意义。
两切口技术所产生的呼吸传感曲线与三切口植入所产生的曲线相当。本分析中收集的有限患者数据表明，使用两切口技术可缩短手术时间。我们的队列中没有术后并发症病例。可以推测，两切口植入由于伤口表面减小，感染风险较低。
