Introduction: Vagus nerve stimulation (VNS) is an established adjunctive surgical treatment for medically intractable epilepsy with over 75 thousand devices implanted worldwide. In disproportion to the many reports documenting efficacy, complications and clinical utility there are very few reports concerning VNS revisions.
Methods: We retrospectively reviewed 1144 consecutive VNS procedures performed by a single epilepsy center between 1998 and 2012 of which 526 (46%) were described as revisions or removals
Results: There were 270 (24%) revisions for battery depletion and 66 (5.8%) for lead malfunction. There were 85 (7.4%) removals for non-efficacy and 54 (3.0%) removals for MRI related issues. Over all infection rate for revisions was 1.2% and average battery life before revision was 4.9 years. There were 6 revisions to manage mechanical issues and 7 miscellaneous procedures that we individually detail.
Conclusions: VNS revisions and removals account for almost one half of all VNS procedures. Our findings describe important long-term expectations for VNS including expected complications and other surgical issues. We discuss our results relating it to efficacy, rational, and long-term expectations in the setting of epilepsy surgery. Review of the literature suggests that this is the only large review of VNS revisions by a single center. Our findings are important to better characterize long-term surgical expectations of VNS therapy. We conclude that VNS therapy retains long-term utility.
Patient Care: VNS revisions and removals account for almost one half of all VNS procedures. Our findings describe important long-term expectations for VNS including expected complications and other surgical issues. Our findings are important to better characterize long-term surgical expectations of VNS therapy which will improve patient care.
Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the importance of the long-term expectatoins for VNS including expected complications and surgical issues. 2)Discuss, in small groups the various revision types. 3)Identify an effective surgical treatment when revision is required.