Intraoperative Monitoring for Vagus Nerve Stimulation

Chiba, Ryohei; Enatsu, Rei; Ochi, Satoko; Yamada, Shoto; Sasagawa, Ayaka; Suzuki, Hime; Yokoyama, Rintaro; Hirano, Tohru; Arihara, Masayasu; Kuribara, Tomoyoshi; Mikuni, Nobuhiro

doi:10.1016/j.wneu.2019.07.210

Cited by 6 publications

(5 citation statements)

References 5 publications

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“…We performed vocal cord monitoring to map the vagal nerve following a previously described protocol. [ 2 , 10 ] A single dose of remifentanil and propofol was used to induce general anesthesia. Muscle relaxants were only administered during intubation.…”

Section: Methodsmentioning

confidence: 99%

“…Endotracheal tube electrodes (Medtronic Xomed, Jacksonville, FL) were used to record the electromyographic (EMG) activity of the vocal cords. [ 2 , 10 ] The electrodes were placed to locate the paired stainless steel wire electrodes in contact with the vocal cords, and correct tube placement was confirmed by recording an electrode impedance of <5 kΩ. The neutral electrode and nerve stimulator anode electrode were placed on the patient’s shoulder.…”

Section: Methodsmentioning

confidence: 99%

“…We have previously reported an intraoperative monitoring technique to prevent electrode misplacement. [ 2 ] However, the vagal nerve and other nerves, such as the ansa cervicalis, cervical plexus, and accessory nerve, could be exposed during VNS placement,[ 2 , 5 , 17 ] and the thresholds of these nerves to induce muscle response have not yet been clarified. A more precise understanding of this region is necessary to differentiate between these nerves.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative nerve stimulation during vagal nerve stimulator placement

Kamada,

Enatsu,

Kanno

et al. 2023

Surgical Neurology International

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Background: Vagal nerve stimulation (VNS) is a palliative treatment for refractory epilepsy and intraoperative nerve stimulation is applied to the vagal and other nerves to prevent electrode misplacement. We evaluated these thresholds to establish intraoperative monitoring procedures for VNS surgery. Methods: Forty-six patients who underwent intraoperative nerve stimulation during VNS placement were enrolled. The vagal nerve and other exposed nerves were electrically stimulated during surgery, and muscle contraction was confirmed by electromyography of the vocal cords and visual recognition of cervical muscle contraction. The nerve thresholds and the most sensitive parts of the vagal nerve were analyzed retrospectively. Results: The stimulation of vagal nerves induced vocal cord responses in all 46 patients; the median thresholds of the most sensitive parts and all parts were 0.2 mA (range: 0.05–0.75 mA) and 0.25 mA (range: 0.15–1.5 mA), respectively. The medial middle region was identified as the most sensitive part of the vagal nerve in the majority of participants (82.5%). In 11 patients, other cervical nerves were stimulated and sternohyoid muscle contraction was induced with a median threshold of 0.35 mA (range: 0.1–0.7 mA) in eight patients, while sternocleidomastoid muscle contraction was induced with a median threshold of 0.2 mA (range: 0.1–0.2 mA) in three. Conclusion: Intraoperative stimulation of vagal nerves induces vocal cord responses with locational variations, and the middle part stimulation could minimize the stimulus intensities. The nerves innervating the sternohyoid and sternocleidomastoid muscles may be exposed during the procedure. Knowledge of these characteristics will enhance the effectiveness of this technique in future applications.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intraoperative nerve stimulation during vagal nerve stimulator placement

Kamada,

Enatsu,

Kanno

et al. 2023

Surgical Neurology International

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“…On exit, the phrenic nerve anastomoses with the ansa cervicalis, putting itself in direct communication with the cervical plexus (C1-C4) and with the vagus nerve (X) [ 20 ]. Indirectly, these connections suggest that the phrenic nerve receives or sends information to the muscles innervated by the ansa cervicalis: sternomastoid, trapezoid, sternohyoid, sternothyroid, omohyoid, thyrohyoid, geniohyoid, and vocal cords [ 21 , 22 ]. Indirectly, through the anastomosis with the X, cranially and extracranially, it contacts the glossopharyngeal nerve (IX) [ 23 ].…”

Section: Reviewmentioning

confidence: 99%

Proposal for Manual Osteopathic Treatment of the Phrenic Nerve

Bordoni,

Escher,

Duczyński

2024

Cureus

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The article reviews the anatomical path of the phrenic nerve and its anastomoses, with the most up-to-date knowledge reported in the literature. We have briefly reviewed the possible phrenic dysfunctions, with the final aim of presenting an osteopathic manual approach for the treatment of the most superficial portion of the nerve, using a gentle technique. The approach we propose is, therefore, a theory based on clinical experience and the rationale that we can extrapolate from the literature. We hope that the article will be a stimulus for further experimental investigations using the technique illustrated in the article. To the authors' knowledge, this is the first article that takes into consideration the hypothesis of an osteopathic treatment with gentle techniques for the phrenic nerve.

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“… 16 – 18 , 30 The SNS effects on the autonomic balance are likely mediated via two neural pathways: direct efferent sacral pathway to the colon and indirect spinal afferent-vagal efferent pathway to the colon. 31 The VNS and SNS are typically applied using a minimally invasive procedure by implanting the VNS electrodes on the cervical vagus 32 , 33 or SNS electrodes in the sacral foramen. 34 Both VNS and SNS neuromodulation procedures have received FDA approval for various indications, demonstrating a well-established safety profile during long-term implantation and use.…”

Section: Introductionmentioning

confidence: 99%

Vagus Nerve Stimulation and Sacral Nerve Stimulation for Inflammatory Bowel Disease: A Systematic Review

Pikov

2023

J Transl Gastroenterol

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Background and objectives: In this systematic review, we assessed the efficacy, potential mechanisms, and safety of two neuromodulation therapies in patients with inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. The first therapy is vagus nerve stimulation (VNS) utilizing implantable or transcutaneous electrodes, and the second is sacral nerve stimulation (SNS) using implantable or percutaneous electrodes. Methods: We conducted a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed database was comprehensively searched, and studies were rigorously assessed for inclusion and exclusion criteria. Results: Our analysis encompassed five clinical studies, three on VNS and two on SNS. Most investigated studies demonstrated significant beneficial effects on IBD symptoms, including disease activity, severity of intestinal lesions, and intestinal pain. When evaluating the impact on key IBD pathophysiologies, both VNS and SNS exhibited trends toward reducing biomarkers of intestinal mucosal inflammation and mitigating sympathetic dominance. Importantly, none of the evaluated neuromodulation methods resulted in long-term adverse effects. Conclusions: Cumulative evidence from the evaluated studies indicates that VNS and SNS therapies effectively alleviate IBD symptoms and may hold promise in addressing the underlying pathophysiologies of IBD, including intestinal mucosal inflammation and sympathetic dominance. Consequently, they represent valuable options for individualized IBD treatment.

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Intraoperative Monitoring for Vagus Nerve Stimulation

Cited by 6 publications

References 5 publications

Intraoperative nerve stimulation during vagal nerve stimulator placement

Intraoperative nerve stimulation during vagal nerve stimulator placement

Proposal for Manual Osteopathic Treatment of the Phrenic Nerve

Vagus Nerve Stimulation and Sacral Nerve Stimulation for Inflammatory Bowel Disease: A Systematic Review

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