caa a22 4500 606215565 CHVBK 20210128101059.0 cr unu---uuuuu 210128e20150401xx s 000 0 eng 10.1007/s00701-015-2362-3 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2362-3 Implantation of a new Vagus Nerve Stimulation (VNS) Therapy® generator, AspireSR®: considerations and recommendations during implantation and replacement surgery—comparison to a traditional system [Elektronische Daten] [Ulf Schneider, Katrin Bohlmann, Peter Vajkoczy, Hans-Beatus Straub] Introduction: The most widely used neuro-stimulation treatment for drug-resistant epilepsy is Vagus Nerve Stimulation (VNS) Therapy®. Ictal tachycardia can be an indicator of a seizure and, if monitored, can be used to trigger an additional on-demand stimulation, which may positively influence seizure severity or duration. A new VNS Therapy generator model, AspireSR®, was introduced and approved for CE Mark in February 2014. In enhancement of former models, the AspireSR has incorporated a cardiac-based seizure-detection (CBSD) algorithm that can detect ictal tachycardia and automatically trigger a defined auto-stimulation. To evaluate differences in preoperative, intraoperative and postoperative handling, we compared the AspireSR to a conventional generator model (Demipulse®). Method: Between February and September 2014, seven patients with drug-resistant epilepsy and ictal tachycardia were implanted with an AspireSR. Between November 2013 and September 2014, seven patients were implanted with a Demipulse and served as control group. Operation time, skin incision length and position, and complications were recorded. Handling of the new device was critically evaluated. Results: The intraoperative handling was comparable and did not lead to a significant increase in operation time. In our 14 operations, we had no significant short-term complications. Due to its larger size, patients with the AspireSR had significantly larger skin incisions. For optimal heart rate detection, the AspireSR had to be placed significantly more medial in the décolleté area than the Demipulse. The preoperative testing is a unique addition to the implantation procedure of the AspireSR, which may provide minor difficulties, and for which we provide several recommendations and tips. The price of the device is higher than for all other models. Conclusions: The new AspireSR generator offers a unique technical improvement over the previous Demipulse. Whether the highly interesting CBSD feature will provide an additional benefit for the patients, and will rectify the additional costs, respectively, cannot be answered in the short-term. The preoperative handling is straightforward, provided that certain recommendations are taken into consideration. The intraoperative handling is equivalent to former models—except for the placement of the generator, which might cause cosmetic issues and has to be discussed with the patient carefully. We recommend the consideration of the AspireSR in patients with documented ictal tachycardia to provide a substantial number of patients for later seizure outcome analysis. Springer-Verlag Wien, 2015 VNS nationallicence Vagus nerve stimulation nationallicence Epilepsy surgery nationallicence Cardiac-based seizure detection nationallicence Schneider Ulf Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany aut Bohlmann Katrin Epilepsy Clinic Tabor, Epilepsy Centre Berlin/Brandenburg, Bernau, Germany aut Vajkoczy Peter Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany aut Straub Hans-Beatus Epilepsy Clinic Tabor, Epilepsy Centre Berlin/Brandenburg, Bernau, Germany aut Acta Neurochirurgica Springer Vienna 157/4(2015-04-01), 721-728 0001-6268 157:4<721 2015 157 701 https://doi.org/10.1007/s00701-015-2362-3 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2362-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Schneider Ulf Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany aut NATIONALLICENCE 700 1- Bohlmann Katrin Epilepsy Clinic Tabor, Epilepsy Centre Berlin/Brandenburg, Bernau, Germany aut NATIONALLICENCE 700 1- Vajkoczy Peter Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany aut NATIONALLICENCE 700 1- Straub Hans-Beatus Epilepsy Clinic Tabor, Epilepsy Centre Berlin/Brandenburg, Bernau, Germany aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/4(2015-04-01), 721-728 0001-6268 157:4<721 2015 157 701