Laryngeal manifestations of cranial nerve IX/X compression at the brainstem

Abstract

Objective We report an association between lower cranial nerve (CN IX/X) vascular compression at the brainstem with laryngeal symptoms utilizing a stepwise algorithm that systematically evaluates and eliminates all other common etiologies. Our experiences with retromastoid craniectomy with lower cranial nerve (LCN) decompression versus non‐neurosurgical treatments are detailed. Study Design Retrospective chart review at a tertiary care academic medical center with follow‐up telephone survey. Methods Baseline demographics, clinical characteristics, quality‐of‐life surveys, and treatment outcomes were recorded for patients with laryngeal symptoms associated with LCN compression at the brainstem. Results Forty‐nine patients demonstrated LCN compression at the brainstem on imaging and presented with chief complaints of dysphonia (25 of 49, 51%), chronic cough (19 of 49, 39%), dysphoric breathing (3 of 49, 6%), and dysphagia (2 of 49, 4%). Poor initial scores were noted for Voice‐Related Quality of Life (V‐RQOL), Reflux Symptom Index, and Glottal Closure Index. Twenty‐four patients underwent LCN decompression, of which 21 of 24 (88%) reported partial, near‐complete, or complete improvement. Major perioperative complications occurred in four of 24 patients (17%). Patients who had undergone decompression were more likely to obtain complete/near‐complete symptom resolution (10 of 24 patients, 42%) compared to those undergoing conservative treatments (2 of 25 patients, 8%) (P = 0.02). V‐RQOL scores improved more in surgical patients [mean change score, 33.0 (standard deviation [SD], 31.2) than nonsurgical patients (mean change score 9.6, SD 20.9) (P = 0.03) (mean follow‐up 3.0 years, SD 2.0). Conclusion Lower cranial nerve compression at the brainstem should be considered when all other etiologies are excluded. Retromastoid craniectomy with LCN decompression demonstrates an acceptable safety profile. Level of Evidence 4 Laryngoscope, 129:2105–2111, 2019