Modified surgical approach to hypoglossal nerve stimulator implantation in the pediatric population

Abstract

Upper airway stimulation with the hypoglossal nerve stimulator is a promising treatment modality for severe obstructive sleep apnea in carefully selected patients with Down syndrome. The pediatric population presents a greater variety in body habitus, including thorax size. A modified surgical approach, utilizing a medially placed, single chest incision, instead of two separate chest incisions, provides an alternative that is particularly useful for pediatric patients with small stature. As this technology is evaluated for Food and Drug Administration clearance in the pediatric population, it is important to consider modifications in surgical technique, partnering prior surgical experience with the technical support of company representatives. Laryngoscope, 128:1490-1492, 2018.

The Hypoglossal Nerve Stimulation as a Novel Therapy for Treating Obstructive Sleep Apnea—A Literature Review

“…All six published manuscripts to date on the use of HGNS in children have been based off a single ongoing clinical trial (NCT02344108, "A Pilot Study to Evaluate the Hypoglossal Nerve Stimulator in Adolescents with Down Syndrome and Obstructive Sleep Apnea"). Of these six manuscripts, three have focused on hypoglossal nerve stimulator efficacy results [68][69][70], while two discussed the surgical approach to hypoglossal nerve stimulator implantation [71,72] and one reported the anesthesia approach to hypoglossal nerve stimulator implantation [73].…”

“…Device implantation is similar to that for adults, with slight modifications. In children, only a single incision is used, and a tunneled approach is used to place the implantable pace generator and respiratory sensing lead [71,72]. Additionally, due to smaller patient size and associated decreased amount of space available in the chest, there is a concern about possible cardiac interference with the sensing lead.…”

Alternative Approaches to Adenotonsillectomy and Continuous Positive Airway Pressure (CPAP) for the Management of Pediatric Obstructive Sleep Apnea (OSA): A Review

“…The hypoglossal nerve (HGN) can be stimulated using an implantable device that can sense respiratory patterns. During inspiration, the HGN stimulator delivers electrical impulses to the medial segment of the hypoglossal nerve during inspiration, resulting in protrusion of the tongue [ 67 ]. Upper airway stimulation with the HGN stimulator has recently been shown to be effective in the management of adults with moderate-to-severe OSA [ 68 ].…”

“…The HGN stimulator has also been shown to be effective in pediatric patients with Down's syndrome and OSA. The use of the HGN stimulator requires surgical placement via a single medial chest incision [ 67 ].…”

Pediatric Modifications to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: How I Do It

“…Although the operative steps of HGNS are well described in adults, the surgical modifications necessary to conduct this procedure in the pediatric population have not been previously elucidated. The authors present their experience with pediatric hypoglossal nerve implantation 6,7 …”