Hypoglossal Nerve Stimulator Explantation: A Case Series

Area of Science:

• Neurosurgery
• Sleep Medicine
• Medical Device Technology

Background:

• Hypoglossal nerve stimulation (HGNS) is an effective treatment for moderate to severe obstructive sleep apnea (OSA) in patients unresponsive to positive airway pressure (PAP) therapy.
• Adverse events leading to HGNS explantation are infrequent and not well-documented.
• This study presents the first case series detailing reasons for HGNS system explantation.

Purpose of the Study:

• To describe the incidence and reasons for explantation of the Inspire HGNS system.
• To identify key factors influencing the decision for HGNS explantation.
• To inform future patient selection and management strategies for HGNS therapy.

Main Methods:

• Retrospective review of five patients who underwent explantation of the Inspire HGNS system.
• Analysis of explantation indications, operative times, and patient outcomes.
• Case series methodology to document clinical experiences.

Main Results:

• Five patients underwent HGNS explantation.
• Primary reasons for explantation included magnetic resonance imaging (MRI) incompatibility (3 patients), poor cosmesis (1 patient), and surgical site infection (1 patient).
• Average operative explant time was 163 minutes.

Conclusions:

• MRI incompatibility, poor cosmesis, and device-related infection are significant reasons for HGNS explantation.
• Potential future requirements for MRI or chest wall surgery should be carefully evaluated during the pre-implantation assessment for HGNS.
• This case series highlights important considerations for the long-term management and potential removal of HGNS devices.