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Revision of Vagal Nerve Stimulator Electrodes Through a Posterior Cervical Triangle Approach: Technical Note

O'Neill, Brent R MD1; Wilberger, James E MD2

doi: 10.1227/NEU.0b013e3181f825a3
Operative Nuances

BACK GROUND: We describe an approach to vagal nerve stimulator (VNS) lead replacement through the posterior cervical triangle. Scar around the structures of the carotid sheath is avoided and new leads are placed on a pristine section of the vagus nerve proximal to the original site.

CLINICAL PRESENTATION: Skin incision from the implantation surgery is incorporated and extended to allow access to the posterior border of the sternocleidomastoid muscle (SCM). Dissection proceeds along the posterior border of the SCM. The SCM and jugular vein are retracted anterior to expose a fresh segment of the vagal nerve immediately superficial to the carotid artery and proximal to the original electrode site. Once the nerve is adequately exposed, electrode placement proceeds in the standard fashion. Dysfunctional electrodes are left in place, and the lead wire is cut as near the electrodes as can be easily accessed. Three patients have undergone lead revision with this approach. Lead placement was successful and free from complications in all cases.

CONCLUSION: The posterior cervical triangle approach provides a virgin dissection plane for VNS revision.

1Division of Pediatric Neurosurgery, The Children's Hospital, University of Colorado, Aurora, Colorado

2Department of Neurosurgery, Allegheny General Hospital, Drexel University School of Medicine, Pittsburgh, Pennsylvania

Received, June 17, 2009.

Accepted, April 12, 2010.

Reprint requests: Brent R. O'Neill, MD, Division of Pediatric Neurosurgery, University of Colorado, 13123 E. 16th Ave., B330, Aurora, CO 80045. E-mail: Boneill35@gmail.com

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