Chronic therapeutic stimulation of the vagal nerve for epilepsy: surgical considerations

The surgical technique for implanting a device for intermittent chronic electrical stimulation of the left vagus nerve in the neck is described as well as the preparatory stages for surgery and the characteristics, functioning and replacement of the device. In order to avoid complications the surgeon must be familiar with the anatomical and physiological principles underlying the technique. If needed, the device may be totally removed with an acceptable morbidity. An MRI of the head can be obtained under certain conditions but MRI of other areas remains contraindicated. On the whole, the implantation of a vagus nerve stimulator is a technically relatively simple, rapid, well-tolerated procedure, which carries few risks.