Revision or replacement of cranial nerve (eg, vagus nerve) neurostimulator electrode array, including connection to existing pulse generator
CPT4 code
Name of the Procedure:
Revision or Replacement of Cranial Nerve Neurostimulator Electrode Array (e.g., Vagus Nerve), Including Connection to Existing Pulse Generator
Common Names: Vagus Nerve Stimulator Revision, VNS Electrode Array Replacement
Summary
This surgical procedure involves either repairing or replacing the electrode array connected to a cranial nerve neurostimulator, such as the vagus nerve stimulator. The procedure also includes reconnecting the new array to the existing pulse generator, which sends electrical impulses to the nerve.
Purpose
The procedure aims to ensure the neurostimulator system works correctly, which is crucial for managing medical conditions like epilepsy or depression that are resistant to other treatments. By revising or replacing the electrode array, the effectiveness of the device is maintained or restored.
Indications
- Inadequate seizure control or symptom relief
- Malfunctioning or damaged electrode array
- Wear and tear over time
- Infection around the implant site
- Changes in clinical needs or patient’s condition
Preparation
- Fasting for at least 8 hours before the procedure
- Temporary discontinuation of certain medications as advised by the doctor
- Preoperative blood tests and possibly imaging studies to map out the current placement of the electrodes
Procedure Description
- The patient is placed under general anesthesia.
- An incision near the previous surgical site allows access to the existing neurostimulator system.
- The surgeon carefully disconnects the malfunctioning or damaged electrode array from the pulse generator.
- A new electrode array is positioned and attached to the cranial nerve, ensuring proper placement and secure connection.
- The new array is then connected to the existing pulse generator.
- The surgeon tests the system to confirm it is functioning as intended before closing the incision with sutures.
Tools: Surgical instruments, electrode array, pulse generator testing device
Anesthesia: General anesthesia
Duration
The procedure typically takes 1 to 2 hours.
Setting
The procedure is performed in a hospital operating room or specialized surgical center.
Personnel
- Neurosurgeon or specialized ENT surgeon
- Anesthesiologist
- Surgical nurses and technicians
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Potential damage to the cranial nerve
- Device malfunction or failure
- Adverse reactions to anesthesia
Benefits
- Improved seizure control or symptom management
- Enhanced device performance and longevity
- Reduced risk of complications from a faulty electrode array
- Immediate testing during surgery to ensure proper function
Recovery
- Hospital stay of 1-2 days for monitoring
- Pain management with prescribed medications
- Avoiding vigorous activities for several weeks
- Follow-up appointments to assess functionality and wound healing
Alternatives
- Medication adjustments or alternative drug therapies
- Non-surgical interventions such as transcranial magnetic stimulation (TMS)
- Other forms of neurostimulation, depending on condition
Patient Experience
During the procedure, patients will be under general anesthesia, so they should not feel any discomfort. Postoperatively, some pain and swelling at the incision site are expected, but manageable with pain relief measures. Patients might require a short period for recovery and observation in the hospital, followed by at-home rest and avoidance of strenuous activities. Regular follow-up ensures optimal outcomes and addresses any concerns.