64568 Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator

Name of the Procedure:

Incision for implantation of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator

Summary

This surgical procedure involves making an incision to implant a device that stimulates the vagus nerve, which is located in the neck. The device includes an electrode array and a pulse generator and is used to help manage certain medical conditions by sending regular electrical pulses to the nerve.

Purpose

The procedure is designed to address conditions such as epilepsy, treatment-resistant depression, and some other neurological disorders. The goal is to reduce the frequency and severity of seizures, improve mood in patients with depression, and generally stabilize neurological functions.

Indications

• Frequent seizures not controlled by medication (epilepsy)
• Treatment-resistant depression
• Cluster headaches
• Chronic pain conditions

Patients suitable for the procedure typically have not responded well to other treatments and have a clear diagnosis of the indicated conditions.

Preparation

• Fasting for at least 8 hours before the surgery.
• Medication review and possible adjustments, particularly blood thinners.
• Preoperative imaging studies, such as MRI or CT scans, to plan the implantation.

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made in the left side of the neck and a small pocket is created in the chest wall for the pulse generator.
3. The electrode array is carefully wrapped around the vagus nerve.
4. Wires from the electrode array are tunneled under the skin to the pulse generator in the chest.
5. The pulse generator, which sends electrical impulses to the electrodes, is implanted and connected.
6. The incisions are closed with sutures.

Duration

The procedure typically takes 1.5 to 2 hours.

Setting

The surgery is usually performed in a hospital operating room.

Personnel

• Neurosurgeon or general surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection at the incision sites
• Bleeding or bruising
• Damage to the vagus nerve
• Device malfunction or displacement
• Hoarseness, coughing, or throat pain
• Rarely, complications from general anesthesia

Benefits

• Reduction in the severity and frequency of seizures
• Improvement in mood for those with treatment-resistant depression
• Potential improvements may be noticed within a few weeks to months following the surgery.

Recovery

• Hospital stay overnight for observation
• Rest and limited activity for several days
• Follow-up appointments to monitor and adjust the device settings
• Full recovery typically takes a few weeks

Alternatives

• Medication adjustments
• Other surgical options, such as deep brain stimulation
• Non-invasive treatments like transcranial magnetic stimulation (TMS)
• Each alternative has its own risks and benefits compared to neurostimulation surgery.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, patients may experience some discomfort at the incision sites and mild throat pain. Pain management will include prescribed medications and comfort measures. Most patients can resume normal activities gradually over a few weeks.