Abstract
Objectives
1) Learn the indications and procedure for vagal nerve stimulator implantation (VNSI) in pediatric patients with refractory seizures. 2) Understand the surgical outcomes and complications for the procedure.
Methods
A retrospective review of prospectively collected data from 2002–2007 was undertaken on VNSI. The cohort consisted of all pediatric patients ages 0–21 at a single institution tertiary children's hospital. All patients were included if they had treatment resistant seizures and had not previously undergone VNSI. The surgical indications, outcomes, complications, and follow-up were recorded.
Results
Over the 5-year period, 36 patients underwent VNSI. Age at surgery ranged from 3 to 20 years (mean 10.5 years). The indications for surgery for all patients included seizures refractory to antiepileptic medications (>5 medications). There were no intraoperative complications and all patients had successful electrode placement as measured by intraoperative testing. After an overnight hospital stay, patients were discharged and programmed by the pediatric neurologist at 2 weeks postoperatively. There were 2 postoperative complications (5.5%), scar hypertrophy of a chest incision and left-sided Horner's syndrome. Both patients have been managed conservatively without sequelae. Follow-up ranged from 6 to 72 months (mean 42 months). There were no device failures and all patients and families were subjectively satisfied with the postoperative result. Intraoperative and postoperative photos will demonstrate technique and outcomes.
Conclusions
Pediatric VNSI is a reliable procedure for refractory seizures with a low complication rate and can be performed safely by otolaryngologists. This represents the largest cohort of pediatric patients in the otolaryngology literature.
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