Motor evoked potential monitoring of the vagus nerve with transcranial electrical stimulation during skull base surgeries

Ito, Eiji; Ichikawa, Masahiro; Itakura, Takeshi; Ando, Hitoshi; Matsumoto, Yuka; Oda, Keiko; Sato, Taku; Watanabe, Tadashi; Sakuma, Jun; Saito, Kiyoshi

doi:10.3171/2012.10.jns12383

Cited by 40 publications

(35 citation statements)

References 31 publications

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“…Although the vocal cord mobility was permanently impaired in three patients (3 %), these patients exhibited occasional hoarseness only when they spoke loudly. Intraoperative motor evoked potential monitoring of the pharyngeal and vocal muscles may be useful to prevent lower cranial nerve dysfunction [21,22].…”

Section: Discussionmentioning

confidence: 99%

Outcome of microvascular decompression for hemifacial spasm associated with the vertebral artery

et al. 2016

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We retrospectively compared the outcome of microvascular decompression (MVD) for hemifacial spasm (HFS) associated with the vertebral artery (VA) with that of MVD for HFS unrelated to the VA. Between April 2008 and April 2015, 22 patients with VA-associated HFS underwent MVD at our institution. The median follow-up period was 28 months (range, 12-90 months). Results were classified as excellent in 19 patients (86 %), good in one (5 %), fair in one (5 %), and poor in one (5 %). Immediate complications developed in five patients (23 %), and one of these complications (5 %) was permanent. The surgical outcome of MVD for VA-associated HFS was similar to that of MVD for HFS unrelated to the VA; however, the incidence of complications was significantly more frequent in patients whose VA compressed the more proximal portion of the facial nerve root exit zone from the caudal side at the pontomedullary sulcus. We conclude that preoperative evaluation of VA compression patterns is important to predict the difficulty of the planned MVD procedure.

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Section: Discussionmentioning

confidence: 99%

Outcome of microvascular decompression for hemifacial spasm associated with the vertebral artery

et al. 2016

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“…Postoperative CN X functional impairment has been reported to occur in 15% to 50% of patients with an increased risk if the tumors involve the jugular foramen. 2,9,16 Preservation of CN X motor function, however, is important because vagal dysfunction causes difficulties with speaking and swallowing (with an increased risk of aspiration and pulmonary infections) and critically impairs quality of life. 17 Both surgical and nonsurgical rehabilitation procedures are time-consuming and do not always guarantee complete restoration of CN X function.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Despite being anecdotally used in many skull base centers, only a few studies particularly evaluated endotracheal surface electrodes for IOM of vocal cord motor function during surgery in the CPA in the park-bench position to date. 2,[9][10][11] To clarify the usefulness of such a monitoring technique, this study was performed.…”

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confidence: 99%

Endotracheal Tube Electrodes to Assess Vocal Cord Motor Function During Surgery in the Cerebellopontine Angle

et al. 2015

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“…Our method may allow assessment of neural integrity in parapharyngeal and cervical surgery, neurosurgery and thoracic surgery, with good approximation to the NIM system (11,12). However, in the case of neural tumor invasion or a large tumor around the nerve, nerve monitoring with an AWS and FNS is difficult.…”

Section: Discussionmentioning

confidence: 99%

Monitoring of recurrent and superior laryngeal nerve function using an Airwayscope™ during thyroid surgery

Ijichi

Sasano

Harima

et al. 2017

Molecular and Clinical Oncology

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Abstract. In thyroid surgery, intraoperative identification and preservation of the recurrent laryngeal nerve (RLN) and superior laryngeal nerve external branch (SLNEB) are crucial. Several reports have proposed that electromyography (EMG) monitoring is an acceptable adjunct for identification and preservation of the RLN. However, a limited number of hospitals have access to an EMG monitoring system. Therefore, the development of another viable monitoring method is required. The aim of the present study was to design a new RLN and SLNEB monitoring method combining an Airwayscope™ (AWS) and a facial nerve stimulator. The facial nerve-stimulating electrode stimulates the RLN or SLNEB, so that the movement of the vocal cord may be observed with an AWS. This monitoring method was performed on 10 patients with a thyroid tumor. In all the cases, RLN and SLNEB were identified and vocal cord function was preserved. All the patients exhibited normal vocal cord function following surgery. Thus, the new RLN and SLNEB monitoring method using an AWS and a facial nerve stimulator is useful in thyroid surgery, and this method may be used as a reliable and available alternative to EMG monitoring to ensure the normal function of the vocal cord. IntroductionIn thyroid surgery, damage to the recurrent laryngeal nerve (RLN) and superior laryngeal nerve external branch (SLNEB) is the most serious complication. Therefore, it is necessary to identify and preserve these nerves. The electromyography (EMG) monitoring system represented by Nerve Integrity Monitor (NIM) (Medtronic Xomed, Jacksonville, FL, USA) is useful for RLN and SLNEB preservation in cases in which the tumor is large, or if there is tumor invasion into the adjacent tissue. Recently, RLN monitoring with an EMG has become widely applied (1-9). Intraoperative nerve monitoring is necessary for nerve function preservation. However, not all hospitals are equipped with an EMG monitoring system and, as a result, RLN and SLNEB monitoring is difficult. Therefore, an alternative monitoring method is required, and it was this need that drove us to design a novel RLN and SLNEB monitoring method. When RLN and SLNEB are stimulated with a facial nerve stimulator (FNS), movement of the vocal cord may be observed with an Airwayscope™ (AWS; Ricoh, Tokyo, Japan), more efficiently compared with the laryngeal fiberscope during surgery. The successful combination of these devices was employed as a complete alternative to EMG. In the present study, we were able to not only monitor and preserve the nerves, but also to confirm the absence of RLN injury following resection. Materials and methodsEquipment. AWS is a laryngoscope currently being used for difficult cases of endotracheal intubation under general anesthesia. A fiberscope is attached to the tip of the laryngoscope blade, from which an image is be observed via a 2.5-inch monitor (Fig. 1). An FNS is commonly used in parotid surgery and neurosurgery. The nerve is electrically stimulated by the FNS probe during surgery (Figs. 2 and 3).Metho...

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Motor evoked potential monitoring of the vagus nerve with transcranial electrical stimulation during skull base surgeries

Cited by 40 publications

References 31 publications

Outcome of microvascular decompression for hemifacial spasm associated with the vertebral artery

Outcome of microvascular decompression for hemifacial spasm associated with the vertebral artery

Endotracheal Tube Electrodes to Assess Vocal Cord Motor Function During Surgery in the Cerebellopontine Angle

Monitoring of recurrent and superior laryngeal nerve function using an Airwayscope™ during thyroid surgery

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