Intraoperative recording of laryngeal adductor reflex and cortical motor evoked potentials during jugular foramen schwannoma surgery: a case report and literature review,Journal of Clinical Monitoring and Computing

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Intraoperative recording of laryngeal adductor reflex and cortical motor evoked potentials during jugular foramen schwannoma surgery: a case report and literature review
Journal of Clinical Monitoring and Computing ( IF 2.0 ) Pub Date : 2022-06-28 , DOI: 10.1007/s10877-022-00880-8
İrem İlgezdi-Kaya _{1,

2,

3} , Elif Ilgaz-Aydınlar ₄ , Pınar Yalınay-Dikmen ₄ , Ramazan Sarı ₅ , İlhan Elmacı ₅

Affiliation

Purpose

Schwannoma, a tumor originating from the peripheral nervous system, may arise from the vagus nerve, although it is not very often. Injury of the vagus nerve by surgical attempts may have consequences that will seriously affect the patient’s quality of life. In recent years, continuous monitoring of the laryngeal adductor reflex (LAR) has become a promising methodology for evaluating vagus nerve function intraoperatively. We refer to our experience changing our surgical strategy due to concurrent deterioration in LAR and CoMEPs intraoperatively. We also provide a literature review and summarize the current knowledge of this technique.

Methods

The LAR was elicited and recorded by an electromyographic endotracheal tube in a 36-year-old man diagnosed with vagal nerve schwannoma. Subdermal needle electrodes were placed in both cricothyroid (CTHY) muscles for corticobulbar motor evoked potentials (CoMEPs) recording.

Results

Recordings of ipsilateral LAR and CTHY CoMEPs were obtained despite preoperative ipsilateral cord vocalis weakness. The surgical strategy was altered after the simultaneous decrease of CTHY CoMEPs and LAR amplitudes, and the surgery was completed with subtotal resection. No additional neurological deficit was observed in the patient except dysphonia, which resolved within a few weeks after the surgery.

Conclusions

We conclude that LAR with vagal nerve CoMEPs are two complementary methods and provide reliable information about the functional status of the vagus nerve during surgery.

中文翻译：

颈静脉孔神经鞘瘤手术中喉内收肌反射和皮质运动诱发电位的术中记录：一例报告并文献复习

目的

神经鞘瘤是一种起源于周围神经系统的肿瘤，可能起源于迷走神经，尽管这种情况并不常见。手术尝试造成的迷走神经损伤可能会产生严重影响患者生活质量的后果。近年来，连续监测喉内收反射（LAR）已成为术中评估迷走神经功能的一种很有前途的方法。我们参考了由于术中 LAR 和 CoMEP 同时恶化而改变手术策略的经验。我们还提供了文献综述并总结了该技术的当前知识。