Microvascular Decompression for Intractable Singultus

Farin, Azadeh; Chakrabarti, Indro; Giannotta, Steven L.; Vaynman, Shoshanna; Samudrala, Srinath

doi:10.1227/01.neu.0000325888.84785.20

Cited by 6 publications

(7 citation statements)

References 77 publications

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“…Dieser Ansatz wurde auch in Einzelfällen von therapierefraktärem Singultus beschrieben, so in einem Bericht über die erfolgreiche Therapie durch mikrochirurgische Dekompression des Nervus vagus an der Schädelbasis [77]. 2008 konnten Farin et al einen bis dahin therapieresistenten Schluckauf durch eine hirnstammnahe Dekompressions-OP erfolgreich kurieren [78].…”

Section: Invasive Therapieverfahrenunclassified

Singultus – Diagnostik und Therapie

Ohlrich¹,

Royl²

2017

Laryngo-Rhino-Otol

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A hiccup is a reflex movement with diffusely distributed afferents and efferents in the thorax; its functional relevance is controversial. In its physiological form, it is mostly a minor complaint that stops spontaneously and rarely leads to medical consultation. However, prolonged agonizing hiccups represent serious deterioration of quality of life. Chronic hiccups by definition last for more than 48 h, with gastroesophageal reflux being the frequent underlying disease. Various other causes affect multiple organ systems, some with serious underlying diseases. A hiccup may be the only symptom at the first manifestation of some neurological disorders. In neuroimaging a lesion of the medulla oblongata is often seen. A NMO and an ischemic stroke with Wallenberg syndrome are 2 frequently underlying neurological diseases, but other inflammatory and vascular diseases and tumors of the central nervous system may be present. No optimal evidencebased recommendations for diagnosis and management of chronic hiccups are available. The search for the underlying disease often requires an interdisciplinary approach by internists, neurologists, and otolaryngologists. Symptomatic treatment may be necessary even before diagnosis. Persistent hiccups, a common problem in oncological palliative care, are often challenging. Proton pump inhibitor or prokinetics are used for treating underlying gastroesophageal reflux and baclofen with or without gabapentin in other cases. Anticonvulsants, antipsychotics, antidepressants, and calcium channel blockers represent other alternative treatment possibilities. In therapy-refractory cases, invasive procedures such as the selective phrenic nerve block are available. More studies are needed to help deal with the diagnostic and therapeutic challenge that hiccups present for neurologists.

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Section: Invasive Therapieverfahrenunclassified

Singultus – Diagnostik und Therapie

Ohlrich¹,

Royl²

2017

Laryngo-Rhino-Otol

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“…Even greater success rates, up to 85%, for neurosurgical decompressions for hemifacial spasm at 10 years have been observed . Similarly, vascular compression of CN X causing intractable hiccups has been described in several case reports, with neurosurgical decompression demonstrating favorable results …”

Section: Introductionmentioning

confidence: 96%

“…10 Additionally, vascular compression of CN X at the brainstem has been seen in intractable hypertension [11][12][13][14] and hiccups. 15,16 When considering treatment options for LCN compression at the brainstem, it is germane to consider other forms of cranial nerve compression at the brainstem. Vascular compression causing trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia are welldescribed phenomena.…”

Section: Introductionmentioning

confidence: 99%

“…23 Similarly, vascular compression of CN X causing intractable hiccups has been described in several case reports, with neurosurgical decompression demonstrating favorable results. 15,16,24,25 This has led to the hypothesis that neurosurgical decompression may benefit those patients with symptomatic compression of LCN at the brainstem associated with a laryngeal symptom and ipsilateral laryngeal finding. To test the validity of this hypothesis, the objective of the present study is to provide the first characterization of laryngeal manifestations of LCN compression at the brainstem and to evaluate the efficacy and safety of neurosurgical decompression versus non-neurosurgical treatments.…”

Section: Introductionmentioning

confidence: 99%

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

Taylor¹,

Lowe²,

Ellis

et al. 2018

The Laryngoscope

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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

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“…Schluckauf durch eine hirnstammnahe Dekompressions-OP erfolgreich kurieren[ 78 ] . Eher zufällig stellten Payne et al fest, dass eine Phrenikus-Blockade mit Lokalanästhetikum bei einem Patienten mit chronischem Schluckauf zunächst ohne Wirkung auf den Schluckauf blieb, dann jedoch auch paralysierende Wirkung auf den N.vagus hatte und mit dem Einsetzen einer Heiserkeit auch der Singultus für die Wirkdauer der Blockade verschwand[ 79 ] .…”

unclassified

Singultus – Diagnostik und Therapie

Ohlrich

Royl

2014

Akt Neurol

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▼ A hiccup is a refl ex movement with diff usely distributed aff erents and eff erents in the thorax; its functional relevance is controversial. In its physiological form, it is mostly a minor complaint that stops spontaneously and rarely leads to medical consultation. However, prolonged agonizing hiccups represent serious deterioration of quality of life. Chronic hiccups by defi nition last for more than 48 h, with gastroesophageal refl ux being the frequent underlying disease. Various other causes aff ect multiple organ systems, some with serious underlying diseases. A hiccup may be the only symptom at the fi rst manifestation of some neurological disorders. In neuroimaging a lesion of the medulla oblongata is often seen. A NMO and an ischemic stroke with Wallenberg syndrome are 2 frequently underlying neurological diseases, but other infl ammatory and vascular diseases and tumors of the central nervous system may be present. No optimal evidencebased recommendations for diagnosis and management of chronic hiccups are available. The search for the underlying disease often requires an interdisciplinary approach by internists, neurologists, and otolaryngologists. Symptomatic treatment may be necessary even before diagnosis. Persistent hiccups, a common problem in oncological palliative care, are often challenging. Proton pump inhibitor or prokinetics are used for treating underlying gastroesophageal refl ux and baclofen with or without gabapentin in other cases. Anticonvulsants, antipsychotics, antidepressants, and calcium channel blockers represent other alternative treatment possibilities. In therapy-refractory cases, invasive procedures such as the selective phrenic nerve block are available. More studies are needed to help deal with the diagnostic and therapeutic challenge that hiccups present for neurologists. Zusammenfassung ▼Der Schluckauf (Singultus) ist ein refl ektorischer Bewegungsablauf mit diff us im Thorax verteilten Aff erenzen und Eff erenzen und kontrovers diskutierter funktioneller Relevanz. In seiner physiologischen Form handelt es sich um eine meist spontan sistierende Bagatellbeschwerde, die nur selten zum Arztkontakt führt. Ein anhaltender quälender Singultus kann jedoch zu einer erheblichen Beeinträchtigung der Lebensqualtiät füh-ren. Ein solcher chronischer Singultus wird im Allgemeinen durch eine Dauer von mehr als 48 h defi niert. Häufi gste zugrundeliegende Erkrankung ist der gastroösophageale Refl ux. Die weiteren Ursachen für einen chronischen Singultus sind vielfältig und betreff en multiple Organsysteme mit zum Teil schwerwiegenden Grunderkrankungen. In einigen Fällen können sich auch neurologische Erkrankungen mit einem Schluckauf präsentieren, zum Teil ist er sogar das einzige Symptom im Rahmen der Erstmanifestation. In der zerebralen Bildgebung fi ndet sich dann häufi g eine Läsion der Medulla oblongata. Eine Neuromyelitis optica und ein ischämischer Hirninfarkt mit Wallenbergsyndrom sind 2 häufi gere zugrundeliegende neurologische Erkrankungen, aber auch andere entzündliche und v...

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Microvascular Decompression for Intractable Singultus

Abstract: Neurovascular compression should be considered a potentially reversible cause of intractable singultus, a significantly disabling clinical phenomenon.

Cited by 6 publications

References 77 publications

Singultus – Diagnostik und Therapie

Singultus – Diagnostik und Therapie

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

Singultus – Diagnostik und Therapie

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