Vagus nerve stimulation lead removal or replacement: surgical technique, institutional experience, and literature overview.
Vagus nerve stimulation lead removal or replacement: surgical technique, institutional experience, and literature overview.
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DOI：
10.1007/s00701-015-2547-9
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发表时间：
2015-11
影响因子：
2.4
通讯作者：
Cornips EM
中科院分区：
文献类型：
--
作者：
Aalbers MW;Rijkers K;Klinkenberg S;Majoie M;Cornips EM
随着迷走神经刺激（VNS）作为难治性癫痫治疗方法的使用越来越多，对完全移除或更换VNS系统的需求也越来越大。我们评估了完全移除或更换VNS系统的安全性和有效性，并对我们的手术技术进行了广泛的描述。我们回顾性审查了2007年1月（首次完全切除的年份）至2014年5月期间进行的所有VNS手术的患者登记。为了评估患者满意度，向患者或其护理人员发送了书面问卷。此外，我们还回顾了有关这一主题的所有文献。22例患者完全取出VNS系统，13例患者完全更换。没有不完整的移除。2例患者的颈静脉小撕裂和1例患者的声带麻痹使翻修手术复杂化。翻修手术后癫痫发作频率未改变或改善。翻修手术后，电极相关副作用均得到改善。21项研究报告了131例完全移除VNS系统的患者。在95例患者中，随后更换了系统。最常报告的副作用是声带麻痹，发生在4名患者中。完全移除或更换VNS系统（包括电极导线和弹簧圈）是可行且安全的。虽然初步结果似乎是有希望的，但需要进一步的研究和更长时间的随访来评估电极导线更换是否会影响VNS的有效性。本文的在线版本（doi：10.1007/s 00701 -015-2547-9）包含补充材料，可供授权用户使用。
With the growing use of vagus nerve stimulation (VNS) as a treatment for refractory epilepsy, there is a growing demand for complete removal or replacement of the VNS system. We evaluate the safety and efficacy of complete removal or replacement of the VNS system and provide an extensive description of our surgical technique. We retrospectively reviewed our patient registry for all VNS surgeries performed between January 2007 (the year of our first complete removal) and May 2014. In order to assess patient satisfaction, a written questionnaire was sent to patients or their caregivers. Additionally, we reviewed all literature on this topic. The VNS system was completely removed in 22 patients and completely replaced in 13 patients. There were no incomplete removals. Revision surgery was complicated by a small laceration of the jugular vein in two patients and by vocal cord paralysis in one patient. Seizure frequency was unaltered or improved after revision surgery. Electrode-related side effects all improved after revision surgery. Twenty-one studies reported a total of 131 patients in whom the VNS system was completely removed. In 95 patients, the system was subsequently replaced. The most frequently reported side effect was vocal cord paresis, which occurred in four patients. Complete removal or replacement of the VNS system including lead and coils is feasible and safe. Although initial results seem promising, further research and longer follow-up are needed to assess whether lead replacement may affect VNS effectiveness. The online version of this article (doi:10.1007/s00701-015-2547-9) contains supplementary material, which is available to authorized users.