Video-assisted thoracoscopic surgery retrieval of a migrated unilateral hypoglossal nerve stimulator sensor lead

Abstract

Obstructive sleep apnea is a common chronic condition typically treated with positive airway pressure. However, many patients have difficulty with adherence to this therapy, and for some, implantation of a hypoglossal nerve stimulator has become an option. Although device implantation is generally well-tolerated, a minority of patients will experience serious adverse events. Here we report the unusual complication of the sensor lead migrating to the costophrenic angle and invading the pleural space. Nine months after original implantation, the sensor lead malfunctioned and was found to be displaced. Initial explantation and reimplantation of a new device resulted in the inability to find a portion of the lead. Reimaging showed the missing lead at the costophrenic angle, and the patient underwent thoracoscopic removal. He resumed therapy with the new device without difficulty. This case demonstrates the ability of the lead to migrate far from the implantation site, which has rarely been reported.

Citation: Rosen R, Padhya T, Daniel J, Sharma A. Video-assisted thoracoscopic surgery retrieval of a migrated unilateral hypoglossal nerve stimulator sensor lead. J Clin Sleep Med. 2024;20(11):1851-1855.

Keywords: hypoglossal nerve stimulator; obstructive sleep apnea; sensor migration.

Figure 1. Normal waveforms (A) and patient’s waveforms (B).

Figure 2. CT chest in axial (A), coronal (B), and sagittal (C) planes.

Red arrows points to sensor lead. CT = computed tomography.

Figure 3. Thoracoscopic view of lead in pleura.