Chyle leak occurring after vagal nerve stimulator implantation in a child.

Vagus nerve stimulation is a therapy indicated for some patients with medically-refractory epilepsy. Typical risks of this procedure include infection, hoarseness, vocal cord dysfunction, and hardware malfunction. Chyle leak via injury to the thoracic duct is a known complication of thoracic and head and neck surgeries-though less so in the neurosurgical literature. In severe cases, chyle leak can lead to nutritional deficiencies and immunosuppression. Management of chyle leak includes low-fat diet and pharmacological suppression of chyle production with medications such as octreotide. If leak is persistent, surgical exploration with attempted ligation of lymphatic structures is performed.