U-shaped Loop：A Strain Relief Loop for Preventing Vagal Nerve Stimulator Lead Fracture

Abstract

Background: Vagal nerve electrical stimulation (VNS) is one of the effective neuromodulatory therapies for drug resistant epilepsy (DRE). Common device complications include lead fracture, device failure or battery dislodgement, resulting in various clinical symptoms. We report a case of lead fracture after VNS surgery, which provides inspiration during VNS surgery. Case presentation: The patient was a 10-year-old child treated with VNS for DRE. The child's body was still growing, and after surgery, he occasionally engaged in physical activity, which led to an increase in the number of seizures after a neck rotation. An examination of the VNS device was performed, which showed that the wire lead was broken. The patient decided to have a VNS replacement surgery. During the operation, we maintain a certain degree of relaxation of the lead through two U-shaped loops as strain relief loops in the neck to prevent the lead fracture during neck activity. Postoperative epilepsy was well controlled, and no more seizures occurred during physical activity and neck rotation. Conclusions: Maintaining a certain degree of relaxation of the lead in the neck during VNS operation can reduce the occurrence of lead fracture caused by the patient's body growth and neck rotation after surgery.