Outcomes of neurosurgery and otolaryngology team surgery for revision vagus nerve stimulation implantation surgery

Comprehensive Summary

This study, conducted by Riccardi et al., compares the outcomes of revision vagus nerve stimulation (VNS) implantation when it’s performed by neurosurgery alone versus by a neurosurgery and otolaryngology team. A chart review of patients undergoing VNS implantation was conducted at a pediatric hospital from 2005 to 2023, and revision cases were compared by surgical team composition, collecting operative details, postoperative symptoms, and pre- and postoperative laryngoscopy findings. Fisher’s statistical analysis was used. There were 104 patients in total, and 14 of those cases involved an additional otolaryngology team and had higher rates of pre- and postoperative flexible laryngoscopy than those performed by neurosurgery alone. 12.3% of patients in the neurosurgery-alone group reported postoperative voice changes, while none in the neurosurgery and ENT group did. Postoperative cough occurred more often in the neurosurgery and ENT groups. There were no postoperative swallowing difficulties, and infection rates were low in both groups. Overall, the addition of an otolaryngology team increased laryngeal monitoring and is a helpful asset to detect laryngeal abnormalities in medically vulnerable pediatric populations.

Outcomes and Implications

This research could provide solutions to vagus nerve injuries during VNS revision to limit voice, swallowing, and airway complications. Since children who undergo VNS revision are likely to have feeding or communication impairments, it is essential to detect and prevent laryngeal injuries early. These findings show that the involvement of an otolaryngology team can be a wonderful asset to the neurosurgery team. This work is relevant to surgical practices because it uses team composition and monitoring strategies to provide a solution rather than specific therapies. The implementation of this idea is feasible within the current surgical system, as it focuses on collaboration among different specialties rather than on new technology.