Endotracheal tube electrodes to map and monitor activities of the vagus nerve intraoperatively. Technical note.
Difficulty swallowing due to damage of the vagus nerve is one of the most devastating complications of surgery in and around the medulla oblongata; therefore, intraoperative anatomical and functional evaluation of this nerve is crucial. The authors applied endotracheal tube surface electrodes to record electromyography (EMG) activity from vocal cords innervated by the vagus nerve. The vagal nucleus or rootlet was electrically stimulated during surgery and vocalis muscle EMG activities were displayed by auditory and visual signals. This technique was used successfully to identify the vagus motor nerve and evaluate its integrity during surgery. The advantages of this method compared with the use of needle electrodes include safe simple electrode placement and stable recording during surgery. In cases involving a pontine cavernoma pressing the nucleus or a jugular foramen tumor encircling the rootlet, this method would be particularly valuable. Additional studies with a larger number of patients are needed to estimate the significance of this method as a means of functional monitoring to predict clinical function.
Mikuni
Nobuhiro
N
Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. mikunin@kuhp.kyoto-u.ac.jp
Satow
Takeshi
T
Taki
Junya
J
Nishida
Namiko
N
Enatsu
Rei
R
Hashimoto
Nobuo
N
D000293:Adolescent; D000328:Adult; D020295:Brain Stem Neoplasms / Q000503:physiopathology / Q000601:surgery*; D002551:Cerebral Ventricle Neoplasms / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D004558:Electric Stimulation; D004566:Electrodes; D004576:Electromyography / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D009046:Motor Neurons / Q000502:physiology; D009620:Nodose Ganglion / Q000293:injuries / Q000503:physiopathology; D011149:Pons / Q000601:surgery*; D012680:Sensitivity and Specificity; D014630:Vagus Nerve / Q000503:physiopathology*; D061223:Vagus Nerve Injuries; D014827:Vocal Cords / Q000294:innervation