Few complications in vagus nerve stimulation surgery for those with drug-resistant epilepsy

Key takeaways:

• Researchers analyzed records of more than 600 vagus nerve stimulation surgeries.
• Mean surgery duration for those with complications was 150.71 minutes compared with 123.64 minutes for those without.

Surgical procedures targeting vagus nerve stimulation for those with drug-resistant epilepsy are generally safe with low incidence and rate of complications, according to research from Brain and Spine.

“Vagus nerve stimulation is the most frequently used method of neuromodulation in patients with epilepsy,” Jouke van Schooten, BS, of the department of health, medicine and life sciences at Maastricht University in the Netherlands, and colleagues wrote. “Although cardiac side effects such as bradycardia or asystole as a result of [vagus nerve stimulation] are very rare, they can occur.”

Prior research has determined that vagus nerve stimulation (VNS) is the most frequently employed neuromodulation treatment for drug-resistant epilepsy (DRE), van Schooten and colleagues wrote, yet complications of VNS surgery include surgical site infection and unilateral vocal cord paresis. The researchers attempted to ascertain the safety profile of VNS-related surgeries for this patient population.

Their retrospective cohort study culled data from files of those with DRE who had undergone primary implantation of a VNS system, replacement of the VNS pulse generator, replacement of the lead, replacement of both pulse generator and lead, or VNS removal surgery at Maastricht University Medical Center. A total of 606 VNS-related procedures, conducted between 2008 and 2022 on 437 individuals, were included for analysis.

Univariable and multivariable logistic regression analysis were performed to analyze possible risk factors, in case of a small sample size, an independent samples t-test and Fisher’s exact test or Pearson’s X2-test were used, with complication rates calculated as a percentage.

According to results, VNS-related procedures led to 67 complications, three of which resulted in permanent complications. The largest subset was primary implantation, performed on 306 individuals, which yielded 41 complications.

Mean surgery duration for those with complications was 150.71 minutes compared with 123.64 minutes for those without.

Researchers further found VNS complication rate after primary implantation was 13.4%: 27.3% for complete VNS removal, 21.4% for lead revision and 2.5% for pulse generator replacement. However, no statistically significant results were found when analyzing the results of adults and children separately.

“This study ... demonstrated that [vagus nerve stimulation] removal or lead revision surgery might be related to a higher complication rate compared to generator replacement or primary implantation,” van Schooten and colleagues wrote.