OBJECTIVE To correlate intraoperative changes of the laryngeal adductor reflex (LAR), alone or in combination with corticobulbar motor evoked potential of vocal muscles (vocal-CoMEPs), with postoperative laryngeal function after posterior fossa and brainstem surgery. METHODS We monitored 53 patients during cerebellar-pontine angle and brainstem surgeries. Vocal-CoMEPs and LAR were recorded from an endotracheal tube with imbedded electrodes or hook-wires electrodes. A LAR significant change (LAR-SC) defined as ≥ 50% amplitude decrement or loss, was classified as either transient or permanent injury to the vagus or medullary pathways by the end of the surgery. RESULTS All patients with permanent LAR loss (n = 5) or LAR-SC (n = 3), developed postoperative laryngeal dysfunction such as aspiration/pneumonia and permanent swallowing deficits (5.6%). Vocal-CoMEP findings refined postoperative vocal motor dysfunction. All seven patients with transient LAR-SC or loss, reverted by changing the surgical approach, did not present permanent deficits. CONCLUSIONS Permanent LAR-SCs or loss correlated with postoperative laryngeal dysfunction and predicted motor and sensory dysfunction of the vagus nerve and reflexive medullary pathways. In contrast, a LAR-SC or loss, averted by a timely surgical adjustment, prevented irreversible damage. SIGNIFICANCE Monitoring of the LAR, with vocal-CoMEPs, may enhance safety to resect complex posterior fossa and brainstem lesions.

中文翻译：

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小脑桥脑角和脑干手术中喉内收肌反射的神经生理监测

目的 将喉内收肌反射 (LAR) 的术中变化，单独或与声带皮质延髓运动诱发电位 (vocal-CoMEP) 结合，与后颅窝和脑干手术后的术后喉功能相关联。方法 我们在小脑桥脑角和脑干手术期间监测了 53 名患者。Vocal-CoMEPs 和 LAR 是从带有嵌入电极或钩线电极的气管插管中记录的。LAR 显着变化 (LAR-SC) 定义为 ≥ 50% 振幅减少或损失，在手术结束时被归类为迷走神经或髓质通路的暂时性或永久性损伤。结果 所有永久性 LAR 丢失 (n = 5) 或 LAR-SC (n = 3) 的患者均出现术后喉功能障碍，如误吸/肺炎和永久性吞咽功能障碍 (5.6%)。Vocal-CoMEP 发现改善了术后声带运动功能障碍。通过改变手术方法恢复的所有 7 名暂时性 LAR-SC 或丢失的患者都没有出现永久性缺陷。结论 永久性 LAR-SCs 或丢失与术后喉功能障碍相关，并预测迷走神经和反射性延髓通路的运动和感觉功能障碍。相比之下，通过及时的手术调整避免 LAR-SC 或损失，防止了不可逆转的损害。意义 使用声带 CoMEP 监测 LAR 可以提高切除复杂后颅窝和脑干病变的安全性。结论 永久性 LAR-SCs 或丢失与术后喉功能障碍相关，并预测迷走神经和反射性延髓通路的运动和感觉功能障碍。相比之下，通过及时的手术调整避免 LAR-SC 或损失，防止了不可逆转的损害。意义 使用声带 CoMEP 监测 LAR 可以提高切除复杂后颅窝和脑干病变的安全性。结论 永久性 LAR-SCs 或丢失与术后喉功能障碍相关，并预测迷走神经和反射性延髓通路的运动和感觉功能障碍。相比之下，通过及时的手术调整避免 LAR-SC 或损失，防止了不可逆转的损害。意义 使用声带 CoMEP 监测 LAR 可以提高切除复杂后颅窝和脑干病变的安全性。