Surgical explantation of a vagal nerve stimulator accord­­ing to the magnetic resonance imaging protocol

Authors: M. Bláha 1;  M. Tomášek 2;  V. Suchánek 3;  P. Marusič 2;  J. Lisý 3;  M. Tichý 1
Published in: Cesk Slov Neurol N 2019; 82(2): 183-188
Category: Original Paper
doi: 10.14735/amcsnn2019183


Aim: An overview of MRI in patients with implanted vagal nerve stimulator (VNS) and the method of surgical explantation of VNS, reflect­­ing the MRI protocol al­low­­ing the subsequent MRI examination without significant limitations.

Patients and methods: MRI can also be safely performed in patients with the implanted VNS device. Head examination and body examination caudal­ly from Th8 can be performed, but only local radiofrequency coils must be used. Before the MRI, the VNS system must be reprogram­med. If the patient has an explanted generator and the larger part of the electrode, the MRI of the entire body can be performed with any com­mon MRI setting. This applies to a situation where after the explantation there is only a 2- cm part of the electrode left –  cor­respond­­ing to the portion of the electrode on the vagal nerve with fixation anchors.

Results: From June 2016 to June 2018, we explanted a VNS with this approach in six patients. Post-operative course of all patients was without complications. Post-operative control was performed using neck X-ray and CT 3D imaging. Imag­­ing methods showed that the remainder of the electrode on the vagal nerve electrode was ≤ 2 cm. Post-operatively, patients did not have swallowing dif­ficulties, hoarseness or voice changes. Four patients have subsequently already undergone MRI without any dif­ficulties or complications.

Conclusion: Surgical explantation of VNS accord­­ing to the MRI protocol, leav­­ing part of the electrode on the vagal nerve and omitt­­ing the complete preparation of the entire electrode on the nerve, reduces the risk of complications and shortens the duration of the operation. The patient can afterwards safely undergo the MRI of the entire body without any limitations in normal technical settings.










epilepsy – vagal nerve stimulation – device removal


1. Penry JK, Dean JC. Prevention of intractable partial seizures by intermittent vagal stimulation in humans: preliminary results. Epilepsia 1990; 31 (Suppl 2): S40– S43. 
2. Ben-Menachem E, Mañon-Espail­lat R, Ristanovic R et al. Vagus nerve stimulation for treatment of partial seizures: 1. A control­led study of ef­fect on seizures. First International Vagus Nerve Stimulation Study Group. Epilepsia 1994; 35(3): 616– 626. 
3. Ramsay RE, Uthman BM, Augustins­son LE et al. Vagus nerve stimulation for treatment of partial seizures: 2. Safety, side ef­fects, and tolerability. First International Vagus Nerve Stimulation Study Group. Epilepsia 1994; 35(3): 627– 636. 
4. Cardion s. r. o. Databáze pa­cientů. Brno 2018.
5. Spanaki MV, Al­len LS, Muel­ler WM et al. Vagus nerve stimulation ther­apy: 5-year of greater outcome at a university-based epilepsy center. Seizure 2004; 13: 587– 590. 
6. DeGiorgio CM, Schachter SC, Handforth A et al. Prospective long term study of vagus nerve stimulation for the treatment of refractory seizures. Epilepsia 2000; 41(9): 1195– 1200. 
7. Chrastina J, Novak Z, Zeman T et al. Single-center long-term results of vagus nerve stimulation for epilepsy: A 10– 17 year fol­low-up study. Seizure 2018; 59: 41– 47. doi: 10.1016/ j. seizure. 2018. 04. 022. 
8. Englot DJ, Rolston JD, Wright CW et al. Rates and predictors of seizure freedom with vagus nerve stimu­lation for intractable epilepsy. Neurosurgery 2016; 79(3): 345– 353. doi: 10.1227/ NEU.0000000000001165. 
9. Reid SA. Surgical technique for implantation of the neurocybernetic prosthesis. Epilepsia 1990; 31(Suppl 2): S38– S39. 
10. Kuba R, Brázdil M, Kalina M et al. Vagus nerve stimulation: longitudinal fol­low-up of patients treated for 5 years. Seizure 2009; 18(4): 269– 274. doi: 10.1016/ j.seizure.2008.10.012.
11. Kovac S, Vakharia VN, Scott C et al. Invasive epilepsy surgery evaluation. Seizure 2017; 44: 125– 136. doi: 10.1016/ j.seizure. 2016.10.016. 
12. Ryvlin P, Cross JH, Rheims S. Epilepsy surgery in children and adults. Lancet Neurol 2014; 13(11): 1114– 1126. doi: 10.1016/ S1474-4422(14)70156-5.
13. Wang ZI, Jones SE, Jaisani Z et al. Voxel-based morphometric magnetic resonance imag­­ing (MRI) postproces­s­­ing in MRI-negative epilepsies. Ann Neurol 2015; 77(6): 1060– 1075. doi: 10.1002/ ana.24407.
14. Hanáková P, Horák O, Ryzí M et al. Identifikace dětských pa­cientů s farmakorezistentní epilepsií a výběr kandidátů nefarmakologické terapie. Cesk Slov Neurol N 2018; 81/ 114(2): 180– 184. doi: 10.14735/ amcsn­n2018180. 
15. Serletis D, Bulacio J, Bingaman W et al. The stereotactic approach for mapp­­ing epileptic networks: a prospective study of 200 patients. J Neurosurg 2014; 121(5): 1239– 1246. doi: 10.3171/ 2014.7.JNS132306.
16. Cyberonics, Inc. MRI Guidelines for VNS Ther­apy®. [online]. Available from URL: http:/ / data/ mri-kompatibilita/ vns-terapie.pdf. 
17. LivaNova, PLC. MRI with the VNS Ther­apy® System. [online]. Available from URL: https:/ / healthcare-profes­sionals/ prescribing-information. 
18. Giordano F, Zicca A, Barba C et al. Vagus nerve stimulation: surgical technique of implantation and revision and related morbidity. Epilepsia 2017; 58 (Suppl 1): 85– 90. doi: 10.1111/ epi.13678. 
19. Gorny KR, Bernstein MA, Watson RE. 3 Tesla MRIof patiens with a vagus nerve stimulator: initial experience us­­ing a T/ R head coil under control­led conditions. J Magn Reson Imag­­ing 2010; 31(2): 475– 481. doi: 10.1002/ jmri. 22037. 
20. de Jonge JC, Melis GI, Gebbink TA et al. Safety of dedicated brain MRI protokol in patiens with a vagus nerve stimulator. Epilepsia 2014; 55(11): e112– e115. doi: 10.1111/ epi.12774.
21. Rösch J, Hamer HM, Men­necke A et al. 3 T-MRI in patients with pharmacoresistant epilepsy and a vagus nerve stimulator: a pilot study. Epilepsy Res 2015; 110: 62– 70. doi: 10.1016/ j.eplepsyres.2014.11.010. 
22. Kahlow H, Olivecrona M. Complications of vagal nerve stimulation for drug-resistant epilepsy: a single center longitudinal study of 143 patients. Seizure 2013; 22(10): 827– 833. doi: 10.1016/ j.seizure.2013.06.011.
23. Couch JD, Gilman AM, Doyle WK. Long-term expectations of vagus nerve stimulation: a look at battery replacement and revision surgery. Neurosurgery 2016; 78(1): 42– 46. doi: 10.1227/ NEU.0000000000000985.
24. Révész D, Rydenhag B, Ben-Menachem E. Complications and safety of vagus nerve stimulation: 25 years of experience at a single center. J Neurosurg Pediatr 2016; 18(1): 97– 104. doi: 10.3171/ 2016.1.PEDS15534.
25. Rijkers K, Berfelo MW, Cornips EM et al. Hardware failure in vagus nerve stimulation ther­apy. Acta Neurochir (Wien) 2008; 150(4): 403– 405. doi: 10.1007/ s00701-007-1492-7.
26. Aalbers MW, Rijkers K, Klinkenberg S et al. Vagus nerve stimulation lead removal or replacement: surgical technique, institutional experience, and literature overview. Acta Neurochir (Wien) 2015; 157(11): 1917– 1924. doi: 10.1007/ s00701-015-2547-9.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 2

2019 Issue 2

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account