During the surgery
Surgery to implant the vagus nerve stimulation device is done either on an outpatient basis, allowing you go to home that same day, or on an inpatient basis, requiring an overnight stay in the hospital.
The surgery usually takes one to two hours. You may remain awake but have medication to numb the surgery area (local anesthesia) or you may be unconscious during the surgery (general anesthesia).
The surgery itself doesn't involve your brain. Two incisions are made, one on your chest and the other on the left side of the neck. The pulse generator is implanted in the upper left side of your chest. The device is meant to be a permanent implant, but it can be removed if necessary.
The pulse generator is about the size of a stopwatch and runs on battery power. A lead wire is connected to the pulse generator. The lead wire is guided under your skin from your chest up to your neck, where it's attached to the left vagus nerve through a second incision.
After the procedure
The pulse generator is turned on during a visit to your doctor's office a few weeks after surgery. Then it can be programmed to deliver electrical impulses to the vagus nerve at various durations, frequencies and currents.
Vagus nerve stimulation usually starts at a low level and is gradually increased, depending on your symptoms and side effects.
Stimulation is programmed to turn on and off in specific cycles. You may have some tingling sensations or slight pain in your neck when the nerve stimulation is on.
The stimulator doesn't detect seizure activity or depression symptoms. When it's turned on, the stimulator turns on and off at the intervals selected by your doctor.
You'll be given a hand-held magnetic device so that you can control the stimulation yourself. This enables you to temporarily turn off the vagus nerve stimulation, which may be necessary when you do certain activities such as public speaking, singing or exercising, or when you're eating if you have swallowing problems. It also allows you to turn it on if you feel the warning signs of a seizure.
You must visit your doctor periodically to make sure that the pulse generator is working correctly and that it hasn't shifted out of position.
For safety concerns, magnetic resonance imaging (MRI) scanning is typically limited if you have a vagus nerve stimulator. In general, MRIs of the head can be done if the right type of MRI machine is used. However, MRIs of the spine and body can't generally be done with a vagus nerve stimulator in place.
Dec. 04, 2012
- Beekwilder JP, et al. Overview of the clinical applications of vagus nerve stimulation. Journal of Clinical Neurophysiology. 2010;27:130.
- Krahl SE. Vagus nerve stimulation for epilepsy: A review of the peripheral mechanisms. Surgical Neurology International. 2012;3(Suppl 1):S47.
- Chengyuan Wu, et al. Neurostimulation for the treatment of epilepsy: A review of current surgical interventions. Neuromodulation. In press. Accessed
- VNS therapy system — P970003s050. U.S. Food and Drug Administration. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm078532.htm. Accessed Oct. 23, 2012.
- Vagus nerve stimulation. American Association of Neurosurgeons. http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Vagus%20Nerve%20Stimulation.aspx. Accessed Oct. 23, 2012.
- Martin JLR, et al. Systematic review and meta-analysis of vagus nerve stimulation in the treatment of depression: Variable results based on study designs. European Psychiatry 2012;27:147.
- Britton JW (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 24, 2012.