Complete section of the left vagus nerve does not preclude the efficacy of vagus nerve stimulation: illustrative case.
AED = antiepileptic drug
DRE = drug-resistant epilepsy
IPG = implantable pulse generator
VNS = vagus nerve stimulation
neuroma
refractory epilepsy
vagus nerve stimulation
vocal cord palsy
Journal
Journal of neurosurgery. Case lessons
ISSN: 2694-1902
Titre abrégé: J Neurosurg Case Lessons
Pays: United States
ID NLM: 9918227275606676
Informations de publication
Date de publication:
19 Jul 2021
19 Jul 2021
Historique:
received:
25
02
2021
accepted:
02
04
2021
entrez:
20
7
2022
pubmed:
21
7
2022
medline:
21
7
2022
Statut:
epublish
Résumé
Vagus nerve stimulation (VNS) represents a valid therapeutic option for patients with medically intractable seizures who are not candidates for epilepsy surgery. Even when complete section of the nerve occurs, stimulation applied cranially to the involved nerve segment does not preclude the efficacy of VNS. Complete vagus nerve section with neuroma causing definitive left vocal cord palsy has never been previously reported in the literature. Eight years after VNS implant, the patient experienced worsening of seizures; the interrogation of the generator revealed high impedance requiring surgical revision. On surgical exploration, complete left vagus nerve section and a neuroma were found. Vocal cord atrophy was found at immediate postoperative laryngeal inspection as a confirmation of a longstanding lesion. Both of these events might have been caused by direct nerve injury during VNS surgery, and they presented in a delayed fashion. VNS surgery may be complicated by direct damage to the left vagus nerve, resulting in permanent neurological deficits. A complete section of the nerve also enables an efficacious stimulation if applied cranially to the involved segment. Laryngeal examination should be routinely performed before each VNS surgery to rule out preexisting vocal cord dysfunction.
Sections du résumé
BACKGROUND
BACKGROUND
Vagus nerve stimulation (VNS) represents a valid therapeutic option for patients with medically intractable seizures who are not candidates for epilepsy surgery. Even when complete section of the nerve occurs, stimulation applied cranially to the involved nerve segment does not preclude the efficacy of VNS. Complete vagus nerve section with neuroma causing definitive left vocal cord palsy has never been previously reported in the literature.
OBSERVATIONS
METHODS
Eight years after VNS implant, the patient experienced worsening of seizures; the interrogation of the generator revealed high impedance requiring surgical revision. On surgical exploration, complete left vagus nerve section and a neuroma were found. Vocal cord atrophy was found at immediate postoperative laryngeal inspection as a confirmation of a longstanding lesion. Both of these events might have been caused by direct nerve injury during VNS surgery, and they presented in a delayed fashion.
LESSONS
CONCLUSIONS
VNS surgery may be complicated by direct damage to the left vagus nerve, resulting in permanent neurological deficits. A complete section of the nerve also enables an efficacious stimulation if applied cranially to the involved segment. Laryngeal examination should be routinely performed before each VNS surgery to rule out preexisting vocal cord dysfunction.
Identifiants
pubmed: 35854913
doi: 10.3171/CASE21128
pii: CASE21128
pmc: PMC9265221
doi:
Types de publication
Case Reports
Langues
eng
Pagination
CASE21128Informations de copyright
© 2021 The authors.
Déclaration de conflit d'intérêts
Disclosures Dr. Roncon is an employee of PLC, manufacturer of vagus nerve stimulators. Dr. Giordano receives compensation for consulting and he received speaker honorarium from Livanova.
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