Surgical explantation of a vagal nerve stimulator according to the magnetic resonance imaging protocol

Česká verzia

Authors: M. Bláha ¹; M. Tomášek ²; V. Suchánek ³; P. Marusič ²; J. Lisý ³; M. Tichý ¹
Published in the journal: Cesk Slov Neurol N 2019; 82(2): 183-188
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2019183

Summary

Aim: An overview of MRI in patients with implanted vagal nerve stimulator (VNS) and the method of surgical explantation of VNS, reflecting the MRI protocol allowing the subsequent MRI examination without significant limitations.

Patients and methods: MRI can also be safely performed in patients with the implanted VNS device. Head examination and body examination caudally from Th8 can be performed, but only local radiofrequency coils must be used. Before the MRI, the VNS system must be reprogrammed. If the patient has an explanted generator and the larger part of the electrode, the MRI of the entire body can be performed with any common MRI setting. This applies to a situation where after the explantation there is only a 2- cm part of the electrode left – corresponding to the portion of the electrode on the vagal nerve with fixation anchors.

Results: From June 2016 to June 2018, we explanted a VNS with this approach in six patients. Post-operative course of all patients was without complications. Post-operative control was performed using neck X-ray and CT 3D imaging. Imaging methods showed that the remainder of the electrode on the vagal nerve electrode was ≤ 2 cm. Post-operatively, patients did not have swallowing difficulties, hoarseness or voice changes. Four patients have subsequently already undergone MRI without any difficulties or complications.

Conclusion: Surgical explantation of VNS according to the MRI protocol, leaving part of the electrode on the vagal nerve and omitting the complete preparation of the entire electrode on the nerve, reduces the risk of complications and shortens the duration of the operation. The patient can afterwards safely undergo the MRI of the entire body without any limitations in normal technical settings.

患者和方法:

在植入VNS装置的患者中，MRI也可以安全地进行。头部检查和身体检查可以从Th8尾部进行，但只能使用局部射频线圈。在MRI之前，VNS系统必须重新编程。如果患者有一个外植的发电机和电极的更大部分，整个身体的MRI可以在任何常见的MRI设置下进行。这适用于一种情况，即移植后仅剩下电极的2-cm部分—对应于带固定锚的迷走神经上的电极部分。

结果:

从2016年6月到2018年6月，我们用这种方法在6例患者中移植了VNS。所有患者术后均无并发症发生。术后对照采用颈部x线片和CT三维成像。成像方法显示，迷走神经电极上电极的剩余部分≤2cm。术后，患者没有吞咽困难，声音嘶哑或声音变化。四名病人其后已接受核磁共振检查，没有任何困难或并发症。

结论:

根据MRI协议进行VNS手术切除，将部分电极保留在迷走神经上，省去了整个神经电极的完整准备，降低了并发症的风险，缩短了手术时间。患者可以在正常的技术条件下安全的进行全身的MRI检查，没有任何限制。

关键词:

癫痫。磁共振成像。迷走神经刺激。装置移除

Keywords:

Epilepsy – vagal nerve stimulation – device removal

Zdroje

1. Penry JK, Dean JC. Prevention of intractable partial seizures by intermittent vagal stimulation in humans: preliminary results. Epilepsia 1990; 31 (Suppl 2): S40– S43.
2. Ben-Menachem E, Mañon-Espaillat R, Ristanovic R et al. Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. First International Vagus Nerve Stimulation Study Group. Epilepsia 1994; 35(3): 616– 626.
3. Ramsay RE, Uthman BM, Augustinsson LE et al. Vagus nerve stimulation for treatment of partial seizures: 2. Safety, side effects, and tolerability. First International Vagus Nerve Stimulation Study Group. Epilepsia 1994; 35(3): 627– 636.
4. Cardion s. r. o. Databáze pacientů. Brno 2018.
5. Spanaki MV, Allen LS, Mueller WM et al. Vagus nerve stimulation therapy: 5-year of greater outcome at a university-based epilepsy center. Seizure 2004; 13: 587– 590.
6. DeGiorgio CM, Schachter SC, Handforth A et al. Prospective long term study of vagus nerve stimulation for the treatment of refractory seizures. Epilepsia 2000; 41(9): 1195– 1200.
7. Chrastina J, Novak Z, Zeman T et al. Single-center long-term results of vagus nerve stimulation for epilepsy: A 10– 17 year follow-up study. Seizure 2018; 59: 41– 47. doi: 10.1016/ j. seizure. 2018. 04. 022.
8. Englot DJ, Rolston JD, Wright CW et al. Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy. Neurosurgery 2016; 79(3): 345– 353. doi: 10.1227/ NEU.0000000000001165.
9. Reid SA. Surgical technique for implantation of the neurocybernetic prosthesis. Epilepsia 1990; 31(Suppl 2): S38– S39.
10. Kuba R, Brázdil M, Kalina M et al. Vagus nerve stimulation: longitudinal follow-up of patients treated for 5 years. Seizure 2009; 18(4): 269– 274. doi: 10.1016/ j.seizure.2008.10.012.
11. Kovac S, Vakharia VN, Scott C et al. Invasive epilepsy surgery evaluation. Seizure 2017; 44: 125– 136. doi: 10.1016/ j.seizure. 2016.10.016.
12. Ryvlin P, Cross JH, Rheims S. Epilepsy surgery in children and adults. Lancet Neurol 2014; 13(11): 1114– 1126. doi: 10.1016/ S1474-4422(14)70156-5.
13. Wang ZI, Jones SE, Jaisani Z et al. Voxel-based morphometric magnetic resonance imaging (MRI) postprocessing in MRI-negative epilepsies. Ann Neurol 2015; 77(6): 1060– 1075. doi: 10.1002/ ana.24407.
14. Hanáková P, Horák O, Ryzí M et al. Identifikace dětských pacientů s farmakorezistentní epilepsií a výběr kandidátů nefarmakologické terapie. Cesk Slov Neurol N 2018; 81/ 114(2): 180– 184. doi: 10.14735/ amcsnn2018180.
15. Serletis D, Bulacio J, Bingaman W et al. The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients. J Neurosurg 2014; 121(5): 1239– 1246. doi: 10.3171/ 2014.7.JNS132306.
16. Cyberonics, Inc. MRI Guidelines for VNS Therapy®. [online]. Available from URL: http:/ / www.cardion.cz/ data/ mri-kompatibilita/ vns-terapie.pdf.
17. LivaNova, PLC. MRI with the VNS Therapy® System. [online]. Available from URL: https:/ / us.livanova.cyberonics.com/ healthcare-professionals/ prescribing-information.
18. Giordano F, Zicca A, Barba C et al. Vagus nerve stimulation: surgical technique of implantation and revision and related morbidity. Epilepsia 2017; 58 (Suppl 1): 85– 90. doi: 10.1111/ epi.13678.
19. Gorny KR, Bernstein MA, Watson RE. 3 Tesla MRIof patiens with a vagus nerve stimulator: initial experience using a T/ R head coil under controlled conditions. J Magn Reson Imaging 2010; 31(2): 475– 481. doi: 10.1002/ jmri. 22037.
20. de Jonge JC, Melis GI, Gebbink TA et al. Safety of dedicated brain MRI protokol in patiens with a vagus nerve stimulator. Epilepsia 2014; 55(11): e112– e115. doi: 10.1111/ epi.12774.
21. Rösch J, Hamer HM, Mennecke A et al. 3 T-MRI in patients with pharmacoresistant epilepsy and a vagus nerve stimulator: a pilot study. Epilepsy Res 2015; 110: 62– 70. doi: 10.1016/ j.eplepsyres.2014.11.010.
22. Kahlow H, Olivecrona M. Complications of vagal nerve stimulation for drug-resistant epilepsy: a single center longitudinal study of 143 patients. Seizure 2013; 22(10): 827– 833. doi: 10.1016/ j.seizure.2013.06.011.
23. Couch JD, Gilman AM, Doyle WK. Long-term expectations of vagus nerve stimulation: a look at battery replacement and revision surgery. Neurosurgery 2016; 78(1): 42– 46. doi: 10.1227/ NEU.0000000000000985.
24. Révész D, Rydenhag B, Ben-Menachem E. Complications and safety of vagus nerve stimulation: 25 years of experience at a single center. J Neurosurg Pediatr 2016; 18(1): 97– 104. doi: 10.3171/ 2016.1.PEDS15534.
25. Rijkers K, Berfelo MW, Cornips EM et al. Hardware failure in vagus nerve stimulation therapy. Acta Neurochir (Wien) 2008; 150(4): 403– 405. doi: 10.1007/ s00701-007-1492-7.
26. Aalbers MW, Rijkers K, Klinkenberg S et al. Vagus nerve stimulation lead removal or replacement: surgical technique, institutional experience, and literature overview. Acta Neurochir (Wien) 2015; 157(11): 1917– 1924. doi: 10.1007/ s00701-015-2547-9.