Outcomes of neurosurgery and otolaryngology team surgery for revision vagus nerve stimulation implantation surgery.

PURPOSE: Vagus nerve stimulation (VNS) is a well-established FDA-approved option for drug-resistant epilepsy. Injury to the vagus nerve can result in vocal cord immobility, which can lead to significant dysphagia and communication deficits. We hypothesized that neurosurgery-otolaryngology collaboration for revision VNS implantation would reduce postoperative complications compared to neurosurgery-only revision.

METHODS

A retrospective chart review was conducted on all consecutive patients who underwent VNS at a tertiary care children's hospital from 2005 to 2023. Details of the cases were collected, including the reason for surgery, composition of the surgical team, patient outcomes, and pre- and postoperative flexible laryngoscopy findings. Postoperative completion of laryngoscopy and prevalence of symptoms were compared using Fisher's exact test, α = 0.05.

RESULTS

A total of 104 patients underwent VNS placement during the study period; 49/104 (47.1%) were male. ENT intraoperative involvement (NSY + ENT) occurred in 14/104 (13.5%) cases, all of which were revisions. ENT follow-up with flexible laryngoscopy was completed in 7/14 (50.0%) of revision NSY + ENT cases compared with 10/57 (17.5%) of revision cases performed by NSY alone (p = 0.03). None (0/14) of the NSY + ENT revision cases reported postoperative voice changes compared with 7/57 (12.3%) of those performed by NSY alone (p = 0.3). Cough was more common in NSY + ENT (4/14, 28.6% vs 4/57, 7.0%, p = 0.03), while the prevalence of significant pain was comparable between cohorts (2/14, 14.3% vs 2/57, 3.5%, p = 0.6). No difficulty swallowing was reported following revision in either cohort.

CONCLUSIONS

ENT involvement in VNS revisions could prevent common complications such as postoperative voice changes.