Abstract
Vagus nerve stimulation (VNS) has become a well-established therapy for epilepsy and depression, and is emerging to treat inflammatory disease, with the cervical vagus nerve (CVN) as major stimulation site. CVN morphometries are missing for VNS, considering its variability. Morphometric data were obtained from CVNs in 27 cadavers, including branching patterns and histology. Cross-sectional area, greater and lesser diameters averaged 7.2 ± 3.1 mm2, 5.1 ± 1.5 and 4.1 ± 1.3 mm, and were ≤11.0 mm2, ≤7.0 and ≤5.8 mm in 90% of the specimens, respectively. Midline distance (position lateral to the laryngeal eminence) and skin distance (anterior-posterior from skin) averaged 34.5 ± 6.2 and 36.2 ± 9.4 mm, ≤49.0 and ≤41.0 mm in 90%, respectively. Nerve dimensions and surface topography correlated closely, but without gender-, side- or branching-dependent differences. The nerve fascicle number averaged 5.2 ± 3.5. Vagal arteries were observed in 49% of the cases. Negative correlations were found for age and cross-sectional area, as well as subperineural vessel count. Detailed anatomical data on the CVN and its vascularity are given, forming the morphometric basis for VNS refinement, filling an evident gap in light of the CVN being a structure with variable positions and branching. A 35 × 35-mm rule may apply for the CVN position, irrespective of branching or positional variation.
Highlights
Vagus nerve stimulation (VNS) has become a well-established therapy for drug-resistant epilepsy[1,2,3,4,5] and refractory depression[2,6], and is an emerging treatment option for inflammatory bowel disease (IBD)[7,8,9,10,11,12]
Based on anecdotal descriptions contradicting this consistency we recently investigated both topographical relationships of the cervical vagus nerve (CVN) and its branching pattern[28,29]
The anatomy of the CVN, being diverse regarding its fiber qualities and projections, makes it an ideal site for electric stimulation, as a number of modulation procedures can be accomplished via one structure
Summary
Vagus nerve stimulation (VNS) has become a well-established therapy for drug-resistant epilepsy[1,2,3,4,5] and refractory depression[2,6], and is an emerging treatment option for inflammatory bowel disease (IBD)[7,8,9,10,11,12]. A major portion of the CVN is composed of afferent fibers[22], likely related to VNS effects. The CVN is a major site for direct and an alternative indirect (transcutaneous) stimulation zone to auricular VNS approach, as the nerve is accessible there. Clear evidence was found that the CVN is highly variable regarding its position in the carotid sheath, with the www.nature.com/scientificreports/. It has become evident here that further detailed morphological and topographical knowledge of CVN is needed for an optimal surgical approach, the implementation of the VNS devices and/or electrodes. This can potentially contribute to the improvement of the clinical results
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call