Intraoperative Neurological Monitoring During Neck Dissection for Esophageal Cancer With Aberrant Subclavian Artery

Abstract

We report a case of esophageal cancer with a non-recurrent inferior laryngeal nerve associated with aberrant right subclavian artery that was treated by neck dissection using intraoperative neurological monitoring followed by thoracoscopic esophagectomy. A 76-year-old man had dysphagia. Endoscopy revealed thoracic esophageal cancer, and computed tomography revealed the presence of an aberrant right subclavian artery between the esophagus and vertebrae. We performed neck dissection followed by thoracoscopic esophagectomy. During the neck dissection, we confirmed a non-recurrent inferior laryngeal nerve through intraoperative neurological monitoring. No postoperative complications were observed, and the patient was discharged 19 days after surgery. We recommend using intraoperative neurological monitoring to avoid injury to the non-recurrent inferior laryngeal nerve associated with the aberrant right subclavian artery.

Intraoperative recurrent laryngeal nerve monitoring in unconventional thyroid surgery

“… 16 Another paradigmatic adaptation of IONM in case of anatomical abnormality is reported from Kitigawa et al: They emphasized the effectiveness of intraoperative nerve monitoring in case of thoracic esophageal squamous cell carcinoma with aberrant subclavian artery. 16 …”

“…Mushiake et al reported a case of RLN monitoring during an esophageal cancer operation in a patient with double aortic arch Ninomiya et al 15 mentioned the usefulness of IONM for the treatment of thoracic esophageal cancer in a patient with a right aortic arch. 16 Another paradigmatic adaptation of IONM in case of anatomical abnormality is reported from Kitigawa et al: They emphasized the effectiveness of intraoperative nerve monitoring in case of thoracic esophageal squamous cell carcinoma with aberrant subclavian artery. 16 The advantages offered by the use of IONM are not clearly stated in literature.…”

“…16 Another paradigmatic adaptation of IONM in case of anatomical abnormality is reported from Kitigawa et al: They emphasized the effectiveness of intraoperative nerve monitoring in case of thoracic esophageal squamous cell carcinoma with aberrant subclavian artery. 16 The advantages offered by the use of IONM are not clearly stated in literature. The main bias of these data can be represented by the high surgical experience of several centers reporting their own data where there is no statistically significant difference between the intraoperative visualization alone versus the IONM in reducing the rate of RLN injury.…”

“…In literature, the use of IONM is also recommended in patients with anatomical laryngeal alterations because of its reliability in high‐risk cases during revision surgery with the loss of the anatomical landmarks 10 , 11 , 14 , 15 , 16 but it has never been described the use of IONM in case of thyroid surgery in patients with a clinical history of partial laryngeal resection. In such scenarios, the preservation of the remaining RLN after partial laryngectomy is mandatory because any injury would lead to the loss of the laryngeal functions with consequent need of total laryngectomy or permanent tracheostomy and/or gastrostomy.…”

The usefulness of intraoperative neurological monitoring for esophageal cancer with double aortic arch; a case report

“…The IONM is a nerve stimulation monitor that uses a probe to apply electrical stimulation to nerves during surgery and analyzes myoelectric activity. It has been reported that IONM can prevent injury to the nerve during neck dissection [5]. We used the IONM system to confirm myoelectric activity continuously and preserve the bilateral recurrent laryngeal nerves because we could not predict the location of the bilateral recurrent laryngeal nerves due to embryological anomaly and also assumed that a non-recurrent laryngeal nerve might exist.…”