The “vagal ansa”: a source of complication in vagus nerve stimulation

Gopalakrishnan, Chittur Viswanathan; Kestle, John R. W.; Connolly, Mary

doi:10.3171/2014.10.peds14259

Cited by 10 publications

(6 citation statements)

References 10 publications

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“…All patients were followed up at least 2 years post-implantation (mean: 43.9 +/− 14.3 months, range: 27–68 months). After VNS implantation, one patient experienced a short-term complication (transitory voice alteration) and two patients experienced long term complications ( Supplementary Figures S3, S4 ; Supplementary Video 1 ): sternocleidomastoid muscle contraction likely caused by the involuntary stimulation of the superior root of the ansa cervicalis ( 21 ), and severe sinus bradycardia, a rare complication of VNS ( 22–25 ), respectively. Muscle contraction disappeared after a revision surgery with lead replacement for the first patient whereas the implantation of a pacemaker allowed to restart VNS for the second one.…”

Section: Resultsmentioning

confidence: 99%

Vagus nerve stimulation allows to cease maintenance electroconvulsive therapy in treatment-resistant depression: a retrospective monocentric case series

Aboubakr,

Domenech,

Heurtebise

et al. 2024

Front. Psychiatry

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ContextThe use of vagus nerve stimulation (VNS) to reduce or stop electroconvulsive therapy (ECT) in treatment-resistant depression seems promising. The aim of this study was to investigate the efficacy of VNS on the reduction of ECT sessions and mood stabilization.MethodsWe conducted a monocentric retrospective case series of patients who suffered from treatment-resistant depression, treated with ECT and referred to our center for VNS. We investigated the number and the frequency of ECT sessions before and after VNS implantation. Secondary criteria consisted in the Montgomery Åsberg Depression Rating Scale (MADRS) score, number of medical treatments, dosage of the main treatment and length of hospital stays before and after VNS. Additionally, we sent an anonymous survey to psychiatrists and other physicians in our institution to investigate their knowledge and perception of VNS therapy to treat treatment-resistant depression.ResultsSeven patients benefited from VNS: six (86%) were female (mean age of 51.7 +/− 16.0 years at surgery), and five (71%) suffered from bipolar depression (three type I and two type II). All patients were followed up at least 2 years post-implantation (range: 27–68 months). Prior to VNS, six patients were treated by maintenance ECT. After VNS, three (43%) patients did not require maintenance ECT anymore, and three (43%) patients required less frequent ECT session with a mean 14.7 +/− 9.8 weeks between sessions after VNS vs. 2.9 +/− 0.8 weeks before VNS. At last follow-up, 4 (57%) patients had stopped ECT. Five (71%) patients implanted with VNS were good responders (50% decrease relative to baseline MADRS). According to the survey, psychiatrists had a significantly better perception and knowledge of ECT, but a worse perception and knowledge of VNS compared to other physicians.ConclusionVNS is a good option for treatment-resistant depression requiring maintenance ECT dependence. Larger on-going studies will help broaden the implanted patients while strengthening psychiatrists’ knowledge on this therapy.

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Section: Resultsmentioning

confidence: 99%

Vagus nerve stimulation allows to cease maintenance electroconvulsive therapy in treatment-resistant depression: a retrospective monocentric case series

Aboubakr,

Domenech,

Heurtebise

et al. 2024

Front. Psychiatry

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“…Furthermore, the nerve root of the ansa cervicalis may descend as a single nerve trunk with the vagal nerve. [ 4 ] Misplacement of the electrodes or involvement of these nerves may cause neck muscle contraction; although this complication is rare, with an incidence rate of only 2–3%, it is a burdensome complication that nevertheless needs to be avoided. [ 4 , 5 , 13 ] In the limited operative view of the VNS, our monitoring technique accurately identified the vagal nerve and prevented this complication.…”

Section: Discussionmentioning

confidence: 99%

“…[ 6 , 15 ] The misplacement of electrodes results in the ineffectiveness of therapy, as well as stimulation-induced neck muscle contraction. [ 5 , 6 , 13 ] This complication may also be caused by the involvement of the abnormal course of the nerve root of the ansa cervicalis[ 4 ] and reliable identification of the vagal nerve is a key point of this procedure.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative nerve stimulation during vagal nerve stimulator placement

Kamada,

Enatsu,

Kanno

et al. 2023

Surgical Neurology International

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Background: Vagal nerve stimulation (VNS) is a palliative treatment for refractory epilepsy and intraoperative nerve stimulation is applied to the vagal and other nerves to prevent electrode misplacement. We evaluated these thresholds to establish intraoperative monitoring procedures for VNS surgery. Methods: Forty-six patients who underwent intraoperative nerve stimulation during VNS placement were enrolled. The vagal nerve and other exposed nerves were electrically stimulated during surgery, and muscle contraction was confirmed by electromyography of the vocal cords and visual recognition of cervical muscle contraction. The nerve thresholds and the most sensitive parts of the vagal nerve were analyzed retrospectively. Results: The stimulation of vagal nerves induced vocal cord responses in all 46 patients; the median thresholds of the most sensitive parts and all parts were 0.2 mA (range: 0.05–0.75 mA) and 0.25 mA (range: 0.15–1.5 mA), respectively. The medial middle region was identified as the most sensitive part of the vagal nerve in the majority of participants (82.5%). In 11 patients, other cervical nerves were stimulated and sternohyoid muscle contraction was induced with a median threshold of 0.35 mA (range: 0.1–0.7 mA) in eight patients, while sternocleidomastoid muscle contraction was induced with a median threshold of 0.2 mA (range: 0.1–0.2 mA) in three. Conclusion: Intraoperative stimulation of vagal nerves induces vocal cord responses with locational variations, and the middle part stimulation could minimize the stimulus intensities. The nerves innervating the sternohyoid and sternocleidomastoid muscles may be exposed during the procedure. Knowledge of these characteristics will enhance the effectiveness of this technique in future applications.

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“…3 Others have noted that attachments between the superior root of the ansa cervicalis and the epineurium of the vagus nerve may also occur without formation of a vagal ansa. [23][24][25][26][27]30,31 Despite their tendency to course with cranial nerves, motor innervation to the strap muscles is believed to originate solely from C1 to C3 (and rarely C4) spinal nuclei. No known cranial nuclei contribution to strap muscle innervation has been previously documented.…”

Section: Discussionmentioning

confidence: 99%

An Anatomic Variant of the Ansa Cervicalis Precluding Its Use as a Donor Nerve

Zhu

Mohan

Richmon

et al. 2019

Ann Otol Rhinol Laryngol

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Background: The ansa cervicalis is useful for cranial nerve repair, and may be harvested without apparent morbidity. Herein we report an unusual and surgically relevant anatomic variant of the ansa cervicalis. Methods: An adult male with left parotid adenoid cystic carcinoma underwent parotidectomy with upper-division facial nerve resection and planned interposition repair using the ansa cervicalis. The ipsilateral hypoglossal nerve was identified, together with a descending branch producing strap muscle contraction when stimulated. This presumed descendens hypoglossi was unusually large in caliber; further dissection revealed continuity with the vagus nerve. Results: Ansa cervicalis harvest was aborted when its separation from vagus nerve epineurium was not possible. The sural nerve was alternatively harvested. The patient awoke with left vocal fold palsy, which completely resolved within 3 months. Conclusion: Anatomic variants of the ansa cervicalis exist that may preclude graft harvest and place the vagus nerve at risk of inadvertent injury.

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The “vagal ansa”: a source of complication in vagus nerve stimulation

Cited by 10 publications

References 10 publications

Vagus nerve stimulation allows to cease maintenance electroconvulsive therapy in treatment-resistant depression: a retrospective monocentric case series

Vagus nerve stimulation allows to cease maintenance electroconvulsive therapy in treatment-resistant depression: a retrospective monocentric case series

Intraoperative nerve stimulation during vagal nerve stimulator placement

An Anatomic Variant of the Ansa Cervicalis Precluding Its Use as a Donor Nerve

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