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Intraoperative nerve stimulation during vagal nerve stimulator placement
Chie Kamada1, Rei Enatsu1, Aya Kanno1
1Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
Surgical Neurology International
|October 9, 2023
Summary
Intraoperative vagal nerve stimulation (VNS) during epilepsy surgery effectively monitors electrode placement. The medial vagal nerve is most sensitive, requiring lower thresholds for vocal cord response, enhancing surgical safety.
Area of Science:
- Neurosurgery
- Neurology
- Electrophysiology
Background:
- Vagal nerve stimulation (VNS) is a palliative treatment for refractory epilepsy.
- Intraoperative nerve stimulation is used to prevent electrode misplacement during VNS surgery.
Purpose of the Study:
- To evaluate nerve stimulation thresholds for establishing intraoperative monitoring procedures in VNS surgery.
- To identify the most sensitive parts of the vagal nerve for optimal stimulation.
Main Methods:
- Retrospective analysis of 46 patients undergoing VNS placement with intraoperative nerve stimulation.
- Confirmation of muscle contraction via electromyography and visual recognition.
- Analysis of vagal nerve and other exposed cervical nerve stimulation thresholds.
Main Results:
- Vagal nerve stimulation induced vocal cord responses in all patients.
- Median thresholds were 0.2 mA for the most sensitive parts and 0.25 mA for all parts.
- The medial middle region of the vagal nerve was most sensitive (82.5%); other cervical nerves also showed stimulation thresholds.
Conclusions:
- Intraoperative vagal nerve stimulation effectively monitors placement with locational variations.
- Stimulating the middle part of the vagal nerve minimizes intensity.
- Understanding nerve characteristics improves VNS surgical effectiveness.
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