Abstracts

RATIONALE: We report our experience with a new technique for the implantation of a Vagal nerve pulse generator and electrode leads using a single incision. Stimulation of the Vagus nerve has been shown to be efficacious and safe in the treatment of refractory epilepsy. Traditionally, two separate incisions for the device have been used, one for the implantation of the leads and a second for the subcutaneous implantation of the pulse generator. METHODS: Twenty five patients with intractable epilepsy, in whom we have been unable to localize a resectable focus, have undergone placement of a Vagus nerve stimulator using a single transverse cervical incision. Introduced in March of 1999 by Olivier Delalande, M.D., and used at the Wake Forest University Comprehensive Epilepsy Center since June of 1999, our patients have ranged in age from 1 year to 48 years. The pulse generator is placed underneath the pectoralis major muscle, and secured to the fascia of the intercostal musculature. The electrode leads were placed around the Vagus nerve in the usual fashion. Surgery was performed using general anesthesia, on an outpatient basis, with operative times similar to 37 prior cases implanted using a subcutaneous placement of the pulse generator through a separate incision. RESULTS: There were no complications from surgical implantation, or general anesthesia. All devices were interogated in the operating room without difficulty, and continue to be interogatable and adjustable in post-operative follow-up. Cosmetic results for the incision and the contour of the device are favorable compared to the subcutaneous implantation of the pulse generator through a separate incision. CONCLUSIONS: The use of a single transverse cervical incision, combined with a sub-pectoral placement of the pulse generator has offered a safe, effective and cosmetically favorable method for the implantation of the Vagus nerve stimulator in our series of 25 patients with medically refractory epilepsy where resective surgery was not possible.