Abstracts

Upgrading of VNS Devices: Technical Issues

Abstract number : 2.302
Submission category : 9. Surgery / 9C. All Ages
Year : 2019
Submission ID : 2421745
Source : www.aesnet.org
Presentation date : 12/8/2019 4:04:48 PM
Published date : Nov 25, 2019, 12:14 PM

Authors :
Jose Burattini, Clinica Cukiert; Cristine Cukiert, Clinica Cukiert; Pedro Mariani, Clinica Cukiert; Arthur Cukiert, Clinica Cukiert

Rationale: The generator of VNS hardware gets eventually depleted after 5-8 years. People who have been receiving VNS therapy and run out of battery for their devices usually present with an increased seizure frequency. The older devices are not compatible with the new ones and the best option is to replace the old model with a new one. This includes the insertion of a new coil electrode and a new generator. The procedure might be carried out by removing the old electrode around the vagus nerve or by leaving it in place and inserting a new one in a new segment of the vagus nerve.  Methods: Thirteen patients submitted VNS device upgrade were studied. All patients were upgrade from their old 100-103 devices to a 106 Aspire device. In all patients, the previous coil electrode was left in place. The surgical procedure included explantation of the old generator and the re-dissection of the vagus nerve following the trajectory of the cable inserted in the previous procedure. The old electrode was visualized and its wires cut the nearer as possible to the vagus nerve; the electrode itself was left in place. A new more cranial section of the vagus was dissected and the new electrode was implanted there. The whole procedure was carried out without the use of any retractor.  Results: Implantation of the new electrode was adequately performed in all patients. The duration of the second procedure was longer than that of the first one (80 x 50 minutes). Mean in-hospital stay was the same for the primary and secondary procedure (1 day). No hoarseness was noted post-operatively in any patient. Nine out of the 13 patients underwent an MRI after reoperation without any side effects.  Conclusions: Dissecting a new segment of the vagus nerve is a safe and effective technique for VNS device upgrade. Leaving the old electrode in place might help in causing less damage to the nerve. There was no hoarseness post-operatively in these patients in whom no further dissection of the primary site was carried out and no retractors were used.  Funding: No funding
Surgery