Pediatric vagal nerve stimulator explantation: A comprehensive literature review and tertiary care experience.

Abstract

Patients with medically-refractory epilepsy who undergo vagal nerve stimulator (VNS) implantation to reduce seizure burden sometimes require device removal. Complete explantation refers to the removal of both the generator and vagal nerve leads, and is uncommonly performed by otolaryngologists due to the perceived risk associated with lead removal. This comprehensive literature review and case series studies safety outcomes among pediatric patients undergoing complete VNS explantation. Literature review and tertiary care case series. PubMed, Embase, Web of Science, and Google Scholar were searched to identify all articles involving VNS explantation prior to January 2023. A retrospective review of pediatric patients undergoing complete VNS explantation from 2009 to 2023at our tertiary center was also conducted. After screening, 36 articles were retained involving 399 patients (139 confirmed children) who underwent complete VNS explantation. 26 patients (6.5%) experienced 1+ peri/post-operative complications. These included temporary VF paresis or dysphonia (n=14; 3.6%), permanent vocal fold (VF) paralysis/paresis (n=6; 1.5%), internal jugular vein injury (n=4; 1.0%), temporary dysphagia (n=2; 0.50%), and cable-bowstring phenomenon (n=1; 0.25%). Data from our tertiary care center revealed eight patients (6M: 2F) with a mean age of 11.4±6.2 years. Devices were removed for clinical ineffectiveness (n=2), infection (n=2), lead failures (n=2), and increased lead impedance (n=2). Mean total length of implantation was 44.4±40.3 months. Mean follow-up was 44.8±35.2 months. No complications were identified. Complete VNS device removal in pediatric patients is technically feasible with low reported complications. Working alongside neurosurgery, otolaryngologists offer unique expertise in dissection along the vagus nerve and may thus add value to the practice of VNS surgery.