Nimodipine and Microsurgery Induced Recovery of the Vocal Cord after Recurrent Laryngeal Nerve Resection

Abstract

Transection of the recurrent laryngeal nerve leads to permanent palsy of the vocal cord. Experimental studies have confirmed that nimodipine increases the pace of axonal regeneration. We present a case of a 19-year-old male, suffering a thyroid cancer disease, who was subjected to unilateral resection of the recurrent laryngeal nerve during surgery. The nerve was repaired with a nerve graft and the patient further treated with nimodipine for 3 months. Evaluation of the patient showed normalization of voice, movement of the vocal cord on the injured side, and electromyography evidence of reinnervation of the larynx muscles at 15 months after surgery.

Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial

“…2,20,21,24,25 Furthermore, these positive results were also observed in laryngeal 8,14 and maxillofacial surgery 23 and may therefore be transferable to other surgical procedures with nerves at risk.…”

“…The beneficial effect of nimodipine treatment for the protection and regeneration of the facial and cochlear nerves is supported by animal experiments 1,6,8,9,[12][13][14][15] and clinical trials in VS surgery. 2,20,21,24,25 Furthermore, these positive results were also observed in laryngeal 8,14 and maxillofacial surgery 23 and may therefore be transferable to other surgical procedures with nerves at risk.…”

“…Although Voluven 6% is approved by the FDA and no adverse events related to HES (especially renal toxicity) were observed in the present study, the neuroprotective effect of HES is questionable, taking into consideration that animal experiments and clinical trials using nimodipine alone showed evidence of comparable neuroprotective efficacy. 1,6,8,9,[12][13][14][15]23 From a pharmacokinetic point of view, parenteral ni- modipine produces higher drug levels and has a higher neuroprotective efficacy compared with enteral administration. 22 Therefore, a central venous access is needed.…”

Intraoperative brainstem auditory evoked potential pattern and perioperative vasoactive treatment for hearing preservation in vestibular schwannoma surgery

“…Patients with disfiguring palsy (HB >IV)28 showed significantly better results and retained long term socially acceptable facial nerve function in 80% compared with 65% in untreated patients 22. Clinical observations such as delayed facial nerve palsy following termination of vasoactive treatment29 or isolated case reports with successful recovery of recurrent laryngeal nerve function under nimodipine30 indicate a neuroprotective effect of calcium channel blockers.…”

Attempt of peripheral nerve reconstruction during lung cancer surgery

“…Because no previous reports of RLN reconstruction in the thoracic field have been published, our experiences could shed light on intraoperative nerve repair and therefore reduce the rate of postoperative complications for patients with RLN injury. A previous report showed that nimodipine associated with microsurgery could induce vocal cord recovery after RLN resection in thyroid surgery 10. Another study showed satisfactory vocal cord recovery after immediate RLN reconstruction in thyroid cancer patients 3.…”