Lead failure after vagus nerve stimulation implantation: X-ray examination and revision surgery.

Lead failure after vagus nerve stimulation implantation: X-ray examination and revision surgery.

World Neurosurg. 2018 Dec 26;:

Authors: Zhou H, Liu Q, Zhao C, Ma J, Ye X, Xu J

Abstract
OBJECTIVE: This study aimed to assess the most common types of lead failures, identify causes and discuss potential procedures for revision surgery following vagus nerve stimulator implantation in epilepsy patients.
METHODS: In a retrospective study over an 8-year period, 13 patients underwent revision surgery due to lead failure. Lead failure was classified as either lead intrinsic damage or lead pin disengagement from the generator header. In the X-ray image, the authors defined an RC ratio that represented the portion of rear lead connector in the header receptacle. It was used to quantitatively evaluate the mechanical failure of the lead-header interface. Optimal procedures to identify and manage lead failure were established.
RESULTS: All 13 patients presented with high lead impedance ≥ 9 kOhms at the time of revision. Seven of ten patients with lead damage presented with increased seizure frequency after a period of seizure remission. In contrast to lead damages occurring relatively late (> 15 months), lead pin disengagement was usually found within the early months after device implantation. A significant association was found between an elevated RC ratio (≥ 35%) and lead pin disengagement. The microsurgical technique permitted the removal or replacement of the lead without adverse effects.
CONCLUSIONS: The method of measuring the RC ratio developed in this study is feasible for identifying lead disengagement at the generator level. Lead revision was an effective and safe procedure for patients experiencing lead failure.

PMID: 30593965 [PubMed - as supplied by publisher]

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