The usefulness of intraoperative neurological monitoring for esophageal cancer with double aortic arch; a case report

Abstract

Background: Double aortic arch (DAA) is a congenital anomaly of the aorta. Esophageal cancer with DAA is rare, and consequently, the appropriate surgical approach has not been standardized. Herein, we report the utilization of intraoperative neurological monitoring (IONM) system to preserve the function of the recurrent laryngeal nerve. Case presentation: A 79-year-old man with esophageal cancer was diagnosed with DAA incidentally. The descending aorta was located on the right side of the thoracic vertebrae. Safe dissection of the mediastinal lymph nodes was difficult using the right transthoracic approach because of the anatomical abnormalities. During surgery, we used cervical mediastinoscopy combined with the IONM system to preserve the bilateral recurrent laryngeal nerves. Severe complications, including recurrent nerve palsy, were not observed postoperatively. Conclusion: IONM may be useful for evaluation of the function of the recurrent laryngeal nerve, and it would be suitable for atypical cases of esophageal cancer.

Intraoperative recurrent laryngeal nerve monitoring in unconventional thyroid surgery

“…In literature, the use of IONM is also recommended in patients with anatomical laryngeal alterations because of its reliability in high‐risk cases during revision surgery with the loss of the anatomical landmarks 10 , 11 , 14 , 15 , 16 but it has never been described the use of IONM in case of thyroid surgery in patients with a clinical history of partial laryngeal resection. In such scenarios, the preservation of the remaining RLN after partial laryngectomy is mandatory because any injury would lead to the loss of the laryngeal functions with consequent need of total laryngectomy or permanent tracheostomy and/or gastrostomy.…”

Esophageal cancer with a double aortic arch: a case report and literature review

“…They reported that the heart's location in the left thorax interrupted middle to lower mediastinal dissection, in contrast to a typical right thoracic approach. Mushiake et al [11] judged that a more familiar method is suitable for that atypical case, so they selected right thoracotomy in the prone position. Kumar et al [12] reported that the right arch of the DAA of their patient was a nondominant arch.…”

“…In our case, we chose the right thoracic approach in the lateral position because the tumor was located in the mid-thoracic esophagus. The first step was the dissection of upper mediastinal LNs and confirmation of the location of the bilateral RLN using cervical mediastinoscopy, which was similar to the method of Mushiake [11]. The inflatable mediastinoscope we use is an improvement based on Fujiwara's [22] method of using mediastinoscopy, which is different from that of Mushiake.…”

“…A 79-year-old man was referred to after an esophageal tumor was found [11]. Histopathological examination of the biopsy samples confirmed the presence of SCC.…”

“…Peng et al [3] chose the posterior mediastinal route, Clement et al [9] placed the anastomosis in the left chest, and the others [5,7,8,10] chose the retrosternal route. Mushiake et al [11] believed that the posterior mediastinal route was better because it avoided the compression of the reconstruction route by the sternoclavicular joint. However, DAA patients have adhesions around the esophagus because of long-term contact between the trachea and DAA.…”