• Hiroshi Hosoyama, Ryosuke Hanaya, Toshiaki Otsubo, Masanori Sato, Yumi Kashida, Sei Sugata, Masaya Katagiri, Koji Iida, and Kazunori Arita.
• Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Epilepsy Center, Kagoshima University Hospital, Kagoshima, Japan.
• World Neurosurg. 2018 Mar 1; 111: 258-260.

BackgroundVagus nerve stimulation (VNS) is a valuable therapeutic option for many types of drug-resistant epilepsy. Muscle hooks and carotid endarterectomy rings have been used for cervical delamination preceding the implantation of stimulation electrodes. The attachment on both sides of a rubber band of Kamiyama-style hanging needles, as are used for scalp and dural retraction during craniotomy, yields a useful tool for VNS implantation. Here we report our experience with this method.MethodsWe present our method using a rubber band plus hooks and a review of 21 consecutive patients who underwent VNS implantation using our rubber band-plus-hooks method.ResultsNone of the 21 patients experienced intraoperative or perioperative complications. Hooks placed in connective tissue around the common carotid artery and jugular vein raised the vagus nerve by elevating the carotid sheath. A single surgeon was able to perform all cervical manipulations under a surgical microscope. The average operation time in this series of 21 patients was 137 minutes.ConclusionsThe use of hooks attached to both sides of a rubber band rendered VNS implantation safer by lifting the vagus nerve and standardizing the procedure.Copyright © 2017 Elsevier Inc. All rights reserved.

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