Lead revision surgery for vagus nerve stimulation in epilepsy: Outcomes and efficacy

•We evaluate clinical outcomes, surgical details, and etiology of VNS lead revision.•VNS lead revision can be performed safely with minimal complications.•The need for revision is rare; surgical skill contributes to the success of the procedure.•Clinical response is restored, and patient self-reported QoL improves.•VNS lead revision should be considered a practical treatment option.

We present, to our knowledge, the first published analysis of vagus nerve stimulation (VNS) lead revisions to incorporate quality of life, clinical response, and antiepileptic drug (AED) burden in postrevision clinical outcomes. Ten patients were followed and had no postoperative complications. Seven patients had improvement in quality of life, and three experienced no change. Eight patients noted a restoration of clinical response comparable with initial VNS implantation. Seven patients reported 30-60% improvement in seizure reduction, two experienced > 60%, and one noted < 30%. Six patients had no change in AED burden. Vagus nerve stimulation lead revision should be considered a safe option for patients with VNS lead failure and medically intractable epilepsy.