The vagus nerve is located in the carotid sheath, between the common carotid artery and the jugular vein, and is the longest traveled and most widely distributed cranial nerve. The efferent nerve fibers originate from the suspensory nucleus and the dorsal nucleus of the vagus nerve and mainly innervate the transverse muscles of the pharynx and most of the internal organs of the thorax and abdomen. The afferent fibers account for 80% of the vagus nerve fibers, most of which end in the nucleus tractus solitarius and project through the nucleus tractus solitarius to the thalamus, limbic system, and cerebral cortex, which allows vagus nerve stimulation to act on the whole brain and increase the level of inhibition in the whole brain. (1) Patients with drug-refractory epilepsy with generalized discharges, or those who cannot clearly locate the epileptic foci and are therefore not suitable for resection surgery; (2) Patients with drug-refractory epilepsy whose conditions are not suitable for craniotomy or who refuse craniotomy; (3) Patients who have already undergone brain surgery for epilepsy and whose efficacy is unsatisfactory or whose surgery has failed and cannot undergo brain surgery again. Contraindications: (1) history of vagotomy; (2) history of severe gastroduodenal ulcer and diabetes mellitus (relatively speaking); (3) history of severe cardiac arrhythmia (relatively speaking); (4) idiosyncratic rejection of the body, unable to tolerate foreign body implantation. 3. Surgical steps and technical points 1. Position: supine position, left shoulder slightly padded, left upper arm abducted, anterior axillary line exposed, head turned 45 degrees to the right, top of the head down 15 degrees. 2. Incision: A transverse incision of 75px was made across the anterior border of the sternocleidomastoid muscle at the level of the inferior border of the thyroid cartilage in the left neck; a longitudinal incision of approximately 100px was made at the upper end of the left anterior axillary line. 3. Reveal the nerve: open the broad cervical muscle, pull the sternocleidomastoid muscle from its anterior edge to the lateral side, open the deep cervical fascia and carotid sheath, pull the internal jugular vein and internal carotid artery to both sides, and reveal the left vagus trunk. Identify and free the vagus nerve trunk about 75px, operate under the microscope to avoid damaging the vagus nerve. 4. Wrap the electrodes: Wrap the spiral stimulation electrodes on the left vagus nerve trunk respectively. Ensure that the fixed end is located at the proximal end and the electrode is located at the distal end. The extension leads are fixed on the deep fascia and muscle respectively. 5.Pulse generator placement: A 100px longitudinal incision is made at the upper end of the left anterior axillary line, upward under the internal clavicle, and a capsule is formed between the subcutaneous and the superficial fascia of the pectoralis major muscle. 6.System detection: enter the patient’s name and implantation date, test the impedance and initial current. 7, intraoperative points of attention: the focus of the intraoperative search for the vagus nerve trunk is to find and identify the carotid sheath, and pay attention to protecting the jugular artery after opening the carotid sheath to prevent injury. The length of the vagus nerve trunk should be exposed sufficiently to facilitate microscopic operation. The fiber layer wrapped around the vagus nerve should be removed to reduce the impedance. The clips for fixing the electrodes should be embedded in the deep part of the sternocleidomastoid muscle to prevent skin abrasion and rupture caused by too shallow a position, leading to infection. Postoperative complications and treatment The common postoperative complications are hoarseness, sore throat, choking and dysphagia, which are mild and reversible. Infection is a more serious complication that requires removal of the implanted device. Therefore, extra attention should be paid to incisional care and strict prevention of infection. Prognosis Vagus nerve stimulation for drug-refractory epilepsy is a palliative treatment and an adjunct to drug therapy. The current comprehensive literature reports that the efficiency (>50% reduction in seizure frequency) is generally between 45% and 65%. The longer the duration of VNS treatment, the better the seizure control has been demonstrated, with a 6% complete remission rate of epilepsy over five years of treatment, as well as a significant improvement in the patient’s quality of life.