• Jason John Labuschagne and Niels Hammer.
• Netcare Unitas Hospital, Centurion, South Africa; Department of Neurosurgery, University of Witwatersrand, Johannesburg, South Africa; Department of Pediatric Neurosurgery, Nelson Mandela Children's Hospital, Johannesburg, South Africa. Electronic address: Jason.labuschagne@icloud.com.
• World Neurosurg. 2019 Nov 1; 131: 180-185.

BackgroundVagus nerve stimulation (VNS) has become an increasingly popular procedure for the treatment of epilepsy and depression. Significant complications or side effects associated with VNS surgery may result from either the inadvertent direct injury to the vagus nerve as part of the surgical approach, placement of the electrode, or the concomitant stimulation of vagal efferent fibers. To mitigate these effects, the recognition of anatomic variants that may place the nerve at increased risk is necessary.Case DescriptionDuring microsurgical dissection of the carotid sheath for the implantation of a vagus nerve stimulator in a 17-year-old male patient with refractory epilepsy, additional nonidentified nerve tissue was found running parallel to the vagus nerve. These fibers were two thirds of the thickness of the vagus nerve and ran medial to it, from the most superior to the most inferior aspect of the carotid sheath dissection, found at a distance of at least 4 cm in a craniocaudal direction. This duplicated nerve did not appear to branch from the vagal trunk nor exit the sheath but rather paralleled the course of the vagus nerve. The parallel course and the proximity of the unidentified nerve make this structure likely to be a duplicated vagus nerve.ConclusionsThis is the first reported case of cervical vagus nerve duplication presented in the literature. Surgeons performing VNS implantations should be cognizant of this potential anomaly in order to avoid inadvertent injury to the nerve.Copyright © 2019 Elsevier Inc. All rights reserved.

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