A method for intraoperative recording of the laryngeal adductor reflex during lower brainstem surgery in children

Costa, P.; Gaglini, Pier Paolo; Tavormina, Paolo; Ricci, Federica; Peretta, Paola

doi:10.1016/j.clinph.2018.08.028

Cited by 15 publications

(5 citation statements)

References 5 publications

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“…This technique requires an EMG endotracheal tube alone, with no placement of additional electrodes, and generates bilateral VF adduction triggered by laryngeal supraglottic mucosal stimulation via brainstem synapse 20 To date, LAR-CIONM has been successfully utilized in neck endocrine procedures, anterior cervical spine approaches, vagal schwannoma resections, and pediatric posterior fossa surgeries. 17,22,[25][26][27][31][32][33][34] The initial feasibility study of LAR-CIONM was published in 2018, and data from this article were used to establish LAR-CIONM warning criteria for nerve injury. 22 In the feasibility study, there were 107 monitorable nerves at risk with normal preoperative laryngoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…The second method of vagal CIONM as reported in this case series utilizes a physiologic laryngeal reflex (LAR‐CIONM) to elicit a contractile response in laryngeal musculature. This technique requires an EMG endotracheal tube alone, with no placement of additional electrodes, and generates bilateral VF adduction triggered by laryngeal supraglottic mucosal stimulation via brainstem synapse 20 To date, LAR‐CIONM has been successfully utilized in neck endocrine procedures, anterior cervical spine approaches, vagal schwannoma resections, and pediatric posterior fossa surgeries 17,22,25–27,31–34 . The initial feasibility study of LAR‐CIONM was published in 2018, and data from this article were used to establish LAR‐CIONM warning criteria for nerve injury 22 .…”

Section: Discussionmentioning

confidence: 99%

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Continuous Laryngeal Adductor Reflex Versus Intermittent Nerve Monitoring in Neck Endocrine Surgery

Sinclair¹,

Téllez

Ulkatan

2020

The Laryngoscope

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Objective Intraoperative neuromonitoring (IONM) techniques aim to identify and potentially prevent nerve injury during surgeries. Prior studies into the efficacy of recurrent laryngeal nerve (RLN) IONM convey mixed results, with some claiming equivalence between IONM and no monitoring at all. The goal of the current study was to compare continuous RLN monitoring using the laryngeal adductor reflex (LAR) to intermittent RLN monitoring (intermittent IONM) to determine whether continuous monitoring reduces the incidence of intraoperative RLN injury during neck endocrine surgeries. Methods In this observational, historical case‐control study, a historical cohort of patients monitored with intermittent‐IONM (group 1, n = 130) were compared to prospectively collected data from consecutive nerves‐at‐risk monitored continuously with the LAR (LAR‐CIONM, group 2, n = 205), at a single center by a single surgeon. The test benefit ratio and relative risk reduction (RRR) for LAR‐CIONM over intermittent IONM were calculated. Results For group 1, nine nerves at risk exhibited intraoperative LOS with transient postoperative vocal fold (VF) hypomobility (n = 2) or immobility (VFI, n = 7). For group 2, two nerves at risk (0.98%) had sudden intraoperative LAR LOS following bipolar cautery, resulting in postoperative transient VFI (P = .004). In each group, there was one case of permanent postoperative VFI. The test benefit rate ratio for LAR‐CIONM demonstrated a dramatic effect at 5.23, with an RRR of 81.0%. Conclusion LAR‐CIONM significantly decreased rates of postoperative transient VF paralysis and paresis over intermittent IONM alone (P = .004). Surgeons should be aware of the benefits and limitations of intermittent IONM versus CIONM. Intermittent IONM, although useful in nerve mapping and intraoperative decision making, has minimal benefit for the prevention of nerve injury, whereas CIONM can potentially reduce nerve injury rates and improve patient outcomes. Level of Evidence 3 Laryngoscope, 131:230–236, 2021

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Continuous Laryngeal Adductor Reflex Versus Intermittent Nerve Monitoring in Neck Endocrine Surgery

Sinclair¹,

Téllez

Ulkatan

2020

The Laryngoscope

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“…It is possible that alterations in this transition are related to sudden infant death syndrome, whose frequency is maximum at the same age at which laryngeal descent is completed (4 to 6 months) [77,78]. In theory, as of six months of life, we should record the LAR (either in the clinic or the operating theatre), although it may be necessary to do so with hook wire electrodes if there is no age-appropriate endotracheal tube [79,80].…”

Section: Neurophysiological Limitations In the Developing Central Ner...mentioning

confidence: 99%

The Role of Neurophysiology in Managing Patients with Chiari Malformations

Moncho,

Poca,

Rahnama

et al. 2023

JCM

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Chiari malformation type 1 (CM1) includes various congenital anomalies that share ectopia of the cerebellar tonsils lower than the foramen magnum, in some cases associated with syringomyelia or hydrocephalus. CM1 can cause dysfunction of the brainstem, spinal cord, and cranial nerves. This functional alteration of the nervous system can be detected by various modalities of neurophysiological tests, such as brainstem auditory evoked potentials, somatosensory evoked potentials, motor evoked potentials, electromyography and nerve conduction studies of the cranial nerves and spinal roots, as well as brainstem reflexes. The main goal of this study is to review the findings of multimodal neurophysiological examinations in published studies of patients with CM1 and their indication in the diagnosis, treatment, and follow-up of these patients, as well as their utility in intraoperative monitoring.

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“…Afferent information is carried by the internal branch of the superior laryngeal nerve (IBSLN) to the medulla oblongata, with motor fibers of the vagus nerve (via the RLN) activating laryngeal adductor musculature to initiate vocal fold contraction and airway protection. Previous publications have reported on the utility of this technique for continuously monitoring vagus nerve motor fibers during neck endocrine, cervical spine, and lower brainstem procedures . Due to the anatomical separation of afferent and efferent limbs of the reflex, it was hypothesized that mapping and monitoring of vagus nerve sensory fibers may also be possible using the LAR.…”

Section: Introductionmentioning

confidence: 99%

“…Previous publications have reported on the utility of this technique for continuously monitoring vagus nerve motor fibers during neck endocrine, cervical spine, and lower brainstem procedures. 1,2,4,5 Due to the anatomical separation of afferent and efferent limbs of the reflex, it was hypothesized that mapping and monitoring of vagus nerve sensory fibers may also be possible using the LAR.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative mapping and monitoring of sensory vagal fibers during vagal schwannoma resection

Sinclair¹,

Téllez²,

Roldán³

et al. 2019

The Laryngoscope

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Vagal schwannomas are rare, benign tumors. Intermittent intraoperative neuromonitoring via selective stimulation of splayed motor fibers running on the schwannoma surface to elicit a compound muscle action potential has been previously reported as a method of preserving vagal motor fibers. In this case report, vagal sensory fibers are mapped and continuously monitored intraoperatively during high vagus schwannoma resection using the laryngeal adductor reflex (LAR). Mapping of nerve fibers on the schwannoma surface enabled identification of sensory fibers. Continuous LAR monitoring during schwannoma subcapsular microsurgical dissection enabled sensory (and motor) vagal fibers to be monitored in real time with excellent postoperative functional outcomes. Laryngoscope, 129:E434–E436, 2019

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A method for intraoperative recording of the laryngeal adductor reflex during lower brainstem surgery in children

Cited by 15 publications

References 5 publications

Continuous Laryngeal Adductor Reflex Versus Intermittent Nerve Monitoring in Neck Endocrine Surgery

Continuous Laryngeal Adductor Reflex Versus Intermittent Nerve Monitoring in Neck Endocrine Surgery

The Role of Neurophysiology in Managing Patients with Chiari Malformations

Intraoperative mapping and monitoring of sensory vagal fibers during vagal schwannoma resection

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