Faculty Bibliography

OBJECTIVE: To report the technique of subpectoral (SP) implantation of the vagus nerve stimulator (VNS) generator. METHODS: We retrospectively reviewed and compared demographics and complications from patients receiving either subcutaneous (SQ; n = 107) or SP (n = 138) VNS implants, performed by one surgeon (WKD) between 1999 and 2003. Selection of implant location was made during the preoperative surgeon-patient consultation on the basis of surgeon recommendation and patient preference. RESULTS: The standard VNS generator implantation is performed within a SQ pocket in the left infraclavicular region of the chest. We have modified this technique by placing the generator into a deeper pocket SP, beneath the pectoralis major muscle, while tunneling the electrodes SQ in the usual fashion. The SP group was substantially younger (median age 19 yr) compared with the SQ group (median age 29 yr). At an average follow-up of 52 months for SQ implants and 28.4 months for SP implants, there were 2.9% infections per patient in the SQ group and 2.5% infections per patient in the SP group. There were three cases of excessive generator mobility in the SQ group; no cases occurred in the SP group. CONCLUSION: The SP implantation technique provides an attractive alternative to SQ VNS implantation. With increased soft tissue coverage, we provide improved cosmesis, increased wound durability to tampering and trauma, and a comparable infection rate with the SQ group

A 44-year-old man with a left perinatal stroke and recurrent refractory epilepsy underwent functional MRI (fMRI) for motor and language mapping to determine if further epilepsy surgery could be performed without loss of language. Language was activated excessively in the right hemisphere, with only small areas of left hemisphere activation. This suggests bilateral language dominance acquired secondary to the perinatal stroke with the right hemisphere activation resulting from neonatal neuronal reorganization. Functional data were overlaid onto 3D diffusion tensor tractography, providing a unique image of the right hemisphere language recruitment

BACKGROUND: Resection of lesions in eloquent areas of the brain are sometimes best done with the patient awake. An awake patient provides neurological feedback as the lesion is resected. This increases the chances of a complete resection without leaving a patient neurologically devastated. Unfortunately, this procedure is not always well tolerated by the patient. METHODS: We performed a case series of awake craniotomies using a dexmedetomidine infusion. RESULTS: All 17 patients included in our study tolerated the procedure well with no major complications. CONCLUSIONS: The addition of dexmedetomidine to our technique improves safety and comfort for patients undergoing awake craniotomy