Left Primary Ligation

The case

A vagus nerve stimulator (VNS) treats epilepsy that does not respond to medicine, and it is also approved for hard-to-treat depression. It has a small generator under the skin below the left collarbone and a thin lead tunneled up to the neck, where three spiral coils wrap around the left vagus nerve. About half of all VNS operations are revisions. Most of those are simple battery changes; this page is the bigger operation, where the lead and coils come out too.

The whole system is replaced when the lead breaks or its readings are out of range, when stimulation causes side effects, or after an infection has cleared. Sometimes it is only removed, because the therapy has not helped or so that full MRI scans can be done. The surgeon reopens both old scars and frees the coils from the nerve under the microscope, working through thick scar right next to the carotid artery and the jugular vein. A new lead and generator are then placed the same way as a first implant.

The operation is done under general anesthesia and most people go home the same day or the next morning. Hoarseness and trouble swallowing for a short time are common after the nerve is handled. The main risks are a tear of the jugular vein, which can usually be stitched, and injury to the vagus nerve, which can leave the voice hoarse. Rarely the nerve is too damaged by old, badly placed coils for a new lead to go on.