Topographical features of the vagal nerve at the cervical level in an aging population evaluated by ultrasound

Inamura, Akinori; Nomura, Sadahiro; Sadahiro, Hirokazu; Imoto, Hirochika; Ishihara, Hideyuki; Suzuki, Michiyasu

doi:10.1016/j.inat.2017.03.006

Cited by 7 publications

(12 citation statements)

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“…However, resolution was poor and the only visually obvious components were the hypoechoic jugular vein and carotid artery, with the VN difficult to identify (Knappertz et al, 1998). There has been significant work in creating a database of ultrasound images of the VN to provide neurosurgeons with a resource for predicting the location of the VN and the distribution of the depths of the nerve from the skin's surface (Inamura et al, 2017). Though the use of ultrasound in this manner highlights the ability to view the VN non-invasively in relation to the carotid artery and jugular vein, it also demonstrates the poor resolution for viewing fascicular strucuture, and other pertinent branches (ESL, RLN).…”

Section: Avoiding Off-target Effects By Identifying Off-target Nervesmentioning

confidence: 99%

“…Despite the ability to visualize these superficial nerves, visualizing fascicular organization of the VN with ultrasound poses a unique problem, as it is below skin, fat, and muscle. Current capabilities of the clinical transducers do not allow for high-resolution, non-invasive visualization of the fascicular organization of deep nerves such as the VN (Brown et al, 2016;Inamura et al, 2017). Though non-invasive ultrasound of the VN has been established in the clinical setting for diagnosis of masses of the neck (Giovagnorio & Martinoli, 2001), the depth of penetration is not sufficient to observe fascicular organization, and resolution tends to be poor (Inamura et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Current capabilities of the clinical transducers do not allow for high-resolution, non-invasive visualization of the fascicular organization of deep nerves such as the VN (Brown et al, 2016;Inamura et al, 2017). Though non-invasive ultrasound of the VN has been established in the clinical setting for diagnosis of masses of the neck (Giovagnorio & Martinoli, 2001), the depth of penetration is not sufficient to observe fascicular organization, and resolution tends to be poor (Inamura et al, 2017). In humans, the VN is 36.2 ± 9.4 mm (mean ± SD) from the surface of the skin, with no differences between sides or sexes (Hammer et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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In vivovisualization of pig vagus nerve ‘vagotopy’ using ultrasound

Settell

Kasole

Skubal

et al. 2020

Preprint

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BackgroundPlacement of the clinical vagus nerve stimulating cuff is a standard surgical procedure based on anatomical landmarks, with limited patient specificity in terms of fascicular organization or vagal anatomy. As such, the therapeutic effects are generally limited by unwanted side effects of neck muscle contractions, demonstrated by previous studies to result from stimulation of 1) motor fibers near the cuff in the superior laryngeal and 2) motor fibers within the cuff projecting to the recurrent laryngeal.ObjectiveThe use of patient-specific visualization of vagus nerve fascicular organization could better inform clinical cuff placement and improve clinical outcomes.MethodsThe viability of ultrasound, with the transducer in the surgical pocket, to visualize vagus nerve fascicular organization (i.e. vagotopy) was characterized in a pig model. Ultrasound images were matched to post-mortem histology to confirm the utility of ultrasound in identifying fascicular organization.ResultsHigh-resolution ultrasound accurately depicted the vagotopy of the pig vagus nerve intra-operatively, as confirmed via histology. The stereotypical pseudo-unipolar cell body aggregation at the nodose ganglion was identifiable, and these sensory afferent fascicular bundles were traced down the length of the vagus nerve. Additionally, the superior and recurrent laryngeal nerves were identified via ultrasound.ConclusionsIntraoperative visualization of vagotopy and surrounding nerves using ultrasound is a novel approach to optimize stimulating cuff placement, avoid unwanted activation of motor nerve fibers implicated in off-target effects, and seed patient-specific models of vagal fiber activation to improve patient outcomes.

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Section: Avoiding Off-target Effects By Identifying Off-target Nervesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In vivovisualization of pig vagus nerve ‘vagotopy’ using ultrasound

Settell

Kasole

Skubal

et al. 2020

Preprint

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“…Between 12 and 20 gestational weeks, the vagus nerve shifts to the ventrodorsal direction relatively to the common carotid artery [5][6][7][8].…”

Section: ключові словаmentioning

confidence: 99%

Fetal topography of branches of the cervical and thoracic divisions of the vagus nerves

Lopushniak

Хмара

Palibroda

et al. 2020

ZMJ

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The study of age and individual anatomical variability of vagus nerves and their branches in different age periods of human ontogenesis causes interest among both morphologists and doctors of different specialties. The aim of the study. To find out the topography of the cervical and thoracic divisions of the vagus nerves in human fetuses aged from 4 th to 10 th gestational months. Materials and methods. The research was conducted on 75 preparations of human fetuses ranging from 81.0 to 375.0 mm in parietal-coccygeal length (PCL) using methods of macro-microscopic dissection and morphometry. Results. In human fetuses, the left vagus nerve is placed anteriorly to the left subclavian artery, then on the lateral surface of the Botallo's arterial duct and the aortic arch. In the neck region, the superior cardiac branch departs from the left vagus nerve and goes to the anterior surface of the left common carotid artery.

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“…Despite the ability to visualize these superficial nerves, visualizing fascicular organization of the VN with ultrasound poses a unique problem, as it is below several layers of skin, fat, and muscle. Current capabilities of the clinical transducers do not allow for high-resolution, non-invasive visualization of the fascicular organization of deep nerves such as the VN ( Brown et al, 2016 ; Inamura et al, 2017 ; Ottaviani et al, 2020 ). Though non-invasive ultrasound of the VN has been established in the clinical setting for diagnosis of masses of the neck ( Giovagnorio and Martinoli, 2001 ), the depth of penetration is not sufficient to observe fascicular organization, and resolution tends to be poor ( Inamura et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

In vivo Visualization of Pig Vagus Nerve “Vagotopy” Using Ultrasound

et al. 2021

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Background: Placement of the clinical vagus nerve stimulating cuff is a standard surgical procedure based on anatomical landmarks, with limited patient specificity in terms of fascicular organization or vagal anatomy. As such, the therapeutic effects are generally limited by unwanted side effects of neck muscle contractions, demonstrated by previous studies to result from stimulation of (1) motor fibers near the cuff in the superior laryngeal and (2) motor fibers within the cuff projecting to the recurrent laryngeal.Objective: Conventional non-invasive ultrasound, where the transducer is placed on the surface of the skin, has been previously used to visualize the vagus with respect to other landmarks such as the carotid and internal jugular vein. However, it lacks sufficient resolution to provide details about the vagus fascicular organization, or detail about smaller neural structures such as the recurrent and superior laryngeal branch responsible for therapy limiting side effects. Here, we characterize the use of ultrasound with the transducer placed in the surgical pocket to improve resolution without adding significant additional risk to the surgical procedure in the pig model.Methods: Ultrasound images were obtained from a point of known functional organization at the nodose ganglia to the point of placement of stimulating electrodes within the surgical window. Naïve volunteers with minimal training were then asked to use these ultrasound videos to trace afferent groupings of fascicles from the nodose to their location within the surgical window where a stimulating cuff would normally be placed. Volunteers were asked to select a location for epineural electrode placement away from the fascicles containing efferent motor nerves responsible for therapy limiting side effects. 2-D and 3-D reconstructions of the ultrasound were directly compared to post-mortem histology in the same animals.Results: High-resolution ultrasound from the surgical pocket enabled 2-D and 3-D reconstruction of the cervical vagus and surrounding structures that accurately depicted the functional vagotopy of the pig vagus nerve as confirmed via histology. Although resolution was not sufficient to match specific fascicles between ultrasound and histology 1 to 1, it was sufficient to trace fascicle groupings from a point of known functional organization at the nodose ganglia to their locations within the surgical window at stimulating electrode placement. Naïve volunteers were able place an electrode proximal to the sensory afferent grouping of fascicles and away from the motor nerve efferent grouping of fascicles in each subject (n = 3).Conclusion: The surgical pocket itself provides a unique opportunity to obtain higher resolution ultrasound images of neural targets responsible for intended therapeutic effect and limiting off-target effects. We demonstrate the increase in resolution is sufficient to aid patient-specific electrode placement to optimize outcomes. This simple technique could be easily adopted for multiple neuromodulation targets to better understand how patient specific anatomy impacts functional outcomes.

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Topographical features of the vagal nerve at the cervical level in an aging population evaluated by ultrasound

Cited by 7 publications

References 5 publications

In vivovisualization of pig vagus nerve ‘vagotopy’ using ultrasound

In vivovisualization of pig vagus nerve ‘vagotopy’ using ultrasound

Fetal topography of branches of the cervical and thoracic divisions of the vagus nerves

In vivo Visualization of Pig Vagus Nerve “Vagotopy” Using Ultrasound

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