BACKGROUND: Vagus nerve stimulation (VNS) is a neuromodulatory treatment for refractory epilepsy, involving electrical stimulation of the vagus nerve via a subcutaneously implanted pulse generator. METHOD: We present a step-by-step description of the VNS implantation technique, incorporating tips and tricks from an epilepsy surgeon with over 20 years of experience (MB). CONCLUSION: Proper patient selection, meticulous surgical technique, and comprehensive postoperative care, supported by educational resources such as surgical technique articles, videos, and simulators, are crucial for minimizing complications and optimizing patient outcomes.