Comparative Safety Assessment of Vagus Nerve Stimulator Insertion Techniques: Carotid vs Clavicular
Abstract number :
2.328
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2023
Submission ID :
606
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Paya Yazdan Panah, BS – University of Louisville
Feride Candan, Student/Researcher – M.D. (Neurologist), Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, University of Louisville School of Medicine; Ian Mutchnick, M.D. (Pediatric Neurosurgery) – Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine – Norton Neuroscience Institute and Children's Hospital; Irfan Ali, M.D. (Clinical Neurophysiology/Child Neurology) – Texas Children's Hospital; Cemal Karakas, M.D. (Pediatric Neurology) – Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine – Norton Neuroscience Institute and Children's Hospital
Rationale: Vagus Nerve Stimulation (VNS) is widely used for treating drug-resistant epilepsy (DRE). While carotid insertion has been widely used, clavicular insertion offers a potential alternative, possibly allowing for higher VNS settings with less airway complications. This study aims to provide a safety comparison of both techniques.
Methods: We conducted a retrospective analysis of children (< 21 years) receiving a VNS through a clavicular insertion from May 2017 to December 2022. These were compared to patients during this same time frame who continued to have a traditional carotid implantation. The Mann-Whitney U test was employed to compare continuous variables. The chi-square test or Fisher's exact test, when applicable, were used to compare categorical variables. The significance level was set at p < 0.05 for all statistical tests.
Results: There were 19 patients receiving a clavicular placement and 69 receiving a carotid placement. No significant differences were observed between the two groups in terms of seizure onset age (p=0.64), age at last follow-up (p=0.34), gender distribution (p=0.43), VNS insertion age (p=0.79), hospital admission duration for VNS (p=0.14), or VNS complications (p value ranged from 0.33 to 1.00). A significant difference was noted in the type of VNS model used for the first insertions (p=0.002), with the M1000 model predominantly used in both groups. The current output was also similar in both groups (p=0.31). There was no substantial difference in the number of VNS revisions (p=0.13). The duration between the first VNS insertion and the last interrogation was significantly shorter in the clavicular group (p=0.01). The average duration of the last follow-up was also significantly shorter in the clavicular group (p=0.0007), likely due to the later start of clavicular procedures in our dataset. See Table 1 for details of the results.
Conclusions: Our results indicate that clavicular VNS insertions are comparable to carotid placements in their complications as well as their maximum VNS current outputs. Clavicular insertion can be considered a safe alternative to the carotid approach in patients with DRE undergoing VNS therapy. As with any surgical technique, individual patient characteristics and preferences should be considered when determining the optimal approach. Additional studies with larger sample sizes and longer follow-up periods are needed to validate our findings and provide possible evidence that clavicular placement allows for higher VNS settings with less airway side effects.
Funding: No funding to declare.
Surgery