Neurophysiological monitoring of the laryngeal adductor reflex during cerebellar-pontine angle and brainstem surgery

Téllez, María J.; Mirallave-Pescador, Ana; Seidel, Kathleen; Urriza, Javier; Shoakazemi, Alireza; Raabe, Andreas; Ghatan, Saadi; Deletis, Vedran; Ulkatan, Sedat

doi:10.1016/j.clinph.2020.10.021

Cited by 25 publications

(10 citation statements)

References 27 publications

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“…Even in patients with second‐ or third‐degree atrioventricular block, no clinically relevant changes in heart rate or blood pressure, cardiac arrhythmia, or other hemodynamically important events were identified despite careful monitoring 57 . Similarly, for LAR‐C‐IONM, adverse complications related to the monitoring technique are yet to be reported 7,8,44,58,59 …”

Section: Resultsmentioning

confidence: 99%

“…During C‐IONM, there is some variation in the criteria used for signal “alerts” and these criteria vary depending on the form of C‐IONM utilized 8,38,40,44,55,56,58 The stringency of the criteria applied for raising an “alert” is an important factor that is responsible for the different false‐positive and false‐negative rates noted in the literature. Uniformity in the criteria for “alerts” is essential, and further study is needed to better define the parameters for significant response decrement for each of the C‐IONM methodologies.…”

Section: Resultsmentioning

confidence: 99%

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Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

et al. 2021

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Background Intraoperative neuromonitoring (IONM) techniques have evolved over the past decade into intermittent IONM (I‐IONM) and continuous IONM (C‐IONM) modes of application. Despite many prior publications on both types of IONM, there remains uncertainty about what outcomes should be measured for each form of IONM. The primary objective of this paper is to define categories of benefit for I‐IONM/C‐IONM and to clarify and standardize their reporting outcomes. Methods Expert review consensus statement utilizing modified Delphi methodology. Results I‐IONM provides diagnosis, classification, and prevention of nerve injury through accurate and early nerve identification. C‐IONM provides real‐time information on nerve functional integrity and thus may prevent some types of nerve injury but cannot assist in nerve localization. Sudden mechanisms of nerve injury cannot be predicted or prevented by either technique. Conclusions I‐IONM and C‐IONM are complementary techniques. Future studies evaluating the utility of IONM should focus on outcomes that are appropriate to the type of IONM being utilized.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

et al. 2021

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“…Regarding the warning criteria, it is accepted because LAR amplitude decreases by .50% for brainstem and posterior fossa surgeries. 37 Laryngeal adductor reflex is a recently developed methodology in IOM and promising for surgeries involving lower medulla and lower cranial nerves. However, young children's technical limitations and electrode placement have severe practical difficulties.…”

Section: Laryngeal Adductor Reflexmentioning

confidence: 99%

Intraoperative Neurophysiologic Monitoring and Mapping in Children Undergoing Brainstem Surgery

Deletis,

Seidel,

Fernández-Conejero

2024

Journal of Clinical Neurophysiology

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Summary: Intraoperative neurophysiologic monitoring during surgery for brainstem lesions is a challenge for intraoperative neurophysiologists and surgeons. The brainstem is a small structure packed with vital neuroanatomic networks of long and short pathways passing through the brainstem or originating from it. Many central pattern generators exist within the brainstem for breathing, swallowing, chewing, cardiovascular regulation, and eye movement. During surgery around the brainstem, these generators need to be preserved to maintain their function postoperatively. This short review presents neurophysiologic and neurosurgical experiences of brainstem surgery in children.

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“…[ 32 , 33 ] Since the vagus nerve can be monitorized continuously by this method, LAR-C-IONM canal so be applied in vagal schwannoma, cerebellar-pontine angle, and brainstem surgeries. [ 34 – 38 ] In LAR-C-IONM technique, integrity of both sensorial and motor pathways can be evaluated without applying a vagus probe.…”

Section: Continuous Intraoperative Nerve Monitoring With Laryngeal Adductor Reflex (Lar)mentioning

confidence: 99%

Recent developments of intraoperative neuromonitoring in thyroidectomy

et al. 2021

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At present, intraoperative neuromonitorization (IONM) with surface electrode-based endotracheal tube (ETT) is a standard method in thyroidectomy and can be performed either intermittently IONM (I-IONM) or continuously IONM (C-IONM). Despite the valuable contribution of I-IONM to the thyroidectomy, it still has limitations regarding the recording electrodes and stimulation probe. New approaches for overcoming the limitations of I-IONM and developing the method are taking attention. Most of the technical issues of IONM with surface electrode-based ETT are related with inadequate contact of electrodes to the vocal cords. Nowadays, efficiency of various recording electrodes is under investigation. Recording electrodes such as needle electrodes applied to thyroarytenoid or posterior cricoarytenoid muscle (PCA), surface electrodes applied to the PCA, and needle or adhesive electrodes applied to the tracheal cartilage or skin, can make safe recordings similar to the ETT electrodes. Despite their invasiveness, needle electrodes record higher electromyography (EMG) amplitudes than tube electrodes do. Adhesive surface electrodes make safe EMG recordings, although amplitudes of these electrodes are usually lower than those of the tube electrodes. These different types of electrodes are less affected by tracheal manipulations and amplitude changes are lower compared to the tube electrodes. During C-IONM, an additional stimulation probe is applied to the vagus nerve after dissecting the nerve circumferentially. Recently, without applying a probe, a new continuous monitorization method called laryngeal adductor reflex CIONM (LAR-CIONM) using sensorial, central, and motor components of LAR arch which is an automatic, primitive brainstem reflex protecting the tracheoesophageal tree from foreign body aspiration, has been implemented. Afferent track of LAR communicates laryngeal mucosa to the brainstem by internal branch of the superior laryngeal nerve and efferent track reaches larynx through recurrent laryngeal nerve. Total outcome of LAR activation is the closure of laryngeal entry by bilateral vocal cord adduction. In LAR-CIONM, a stimulus is given by an electrode from one side of surface electrode-based ETT and amplitude response of the LAR at the vocal cord is followed on the operation side. Recently, it has been reported that real-time EMG response can be obtained with stimulation probe cables applied to dissectors or energy devices during the dissection through I-IONM.

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Neurophysiological monitoring of the laryngeal adductor reflex during cerebellar-pontine angle and brainstem surgery

Cited by 25 publications

References 27 publications

Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

Intraoperative Neurophysiologic Monitoring and Mapping in Children Undergoing Brainstem Surgery

Recent developments of intraoperative neuromonitoring in thyroidectomy

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