Type of Surgery
Last updated: 02/17/2009
The vagal nerve stimulator has two parts: an electrode that wraps around the left vagus nerve in the neck; and a pulse generator, which is implanted under the skin below the collarbone. The two parts are connected by a wire. Stimulation is performed...
only on the left vagal nerve, as the right vagal nerve helps control the heartbeat.
Surgery to implant a VNS device takes about two hours. A neurosurgeon implants the electrode and generator while the patient is under general anesthesia. A vertical incision is made in the left side of the neck, and the helical electrode is attached to the nerve itself. A second incision is made on the left side of the chest below the collarbone, and the pulse generator (a disc about 2 in [5 cm] in diameter) is implanted under the skin. The connecting wire is threaded around the muscles and bones to join the electrode and generator. The generator makes a small bulge under the skin but is hidden by clothing after the operation.
Before the neurosurgeon closes the incisions, he or she tests the VNS device to make sure it is working, and programs it to deliver the lowest amount of stimulation. The device is usually timed to stimulate the vagus nerve for 30 seconds every five minutes.
Vagus nerve stimulation (VNS) is an adjunctive treatment for certain types of intractable epilepsy and major depression. VNS uses an implanted stimulator that sends electric impulses to the left vagus nerve in the neck via a lead wire implanted under the skin.
Vagus, the tenth cranial nerve arises from the medulla and carries both afferent and efferent fibers. The afferent vagal fibers connect to the nucleus of the solitary tract which in turn projects connections to other locations in the central nervous system. Little is understood about exactly how vagal nerve stimulation modulates mood and seizure control but proposed mechanisms include alteration of norepinephrine release by projections of solitary tract to the locus coeruleus, elevated levels of inhibitory GABA related to vagal stimulation and inhibition of aberrant cortical activity by reticular system activation
Even patients who had a single metastasis surgically removed should have radiation therapy as there are always individual tumor cells remaining.
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