Vagus nerve stimulation lead durability: Insights from an extensive monocentric single-operator adult series.

Background: Vagus nerve stimulation (VNS) is an established surgical option for neuromodulation. Lead failure is a significant complication mainly reported in children.

Methods: We conducted a retrospective review of all VNS-related surgeries for refractory epilepsy in adults performed by a single experienced surgeon at a French national referral center from November 2011 to March 2023. We analyzed lead survival using Kaplan-Meier estimators and calculated failure rates.

Results: The study included 267 patients (144 females, mean age 36.56 years) with a mean follow-up of 4.32 years. Of 235 leads implanted, accumulating 1355 device years, four lead failures (1.74%) were identified. The cumulative 5-year and 10-year lead survival probabilities were 98.14% (95% CI: 96.06%-100%) and 97.33% (95% CI: 94.75%-100%), respectively. The lead failure rate was 0.00295 events per device-year. All lead failures were associated with abnormally high impedance (>10,000 ohms).

Conclusions: This study characterizes technical VNS lead durability, with a failure rate comparable to other neuromodulation devices. Lead longevity is influenced by technical specifications, surgical techniques, and patient-related factors. To optimize lead durability, surgeons should consider the latest technical developments, adhere to best practices, and provide proper patient counseling. Future research should focus on refining lead design and implantation techniques to further improve long-term outcomes.