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 post operative 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 2005–2023. Details of the cases were collected including reason for surgery, composition of surgical team, patient outcomes, and pre and post operative flexible laryngoscopy findings. Post operative 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) occured 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 post-operative 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 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 post-operative voice changes.