Neurophysiological monitoring of the laryngeal adductor reflex during cerebellar-pontine angle and brainstem surgery.

Téllez, Maria J; Mirallave-Pescador, Ana; Seidel, Kathleen; Urriza, Javier; Shoakazemi, Alireza; Raabe, Andreas; Ghatan, Saadi; Deletis, Vedran; Ulkatan, Sedat (2021). Neurophysiological monitoring of the laryngeal adductor reflex during cerebellar-pontine angle and brainstem surgery. Clinical neurophysiology, 132(2), pp. 622-631. Elsevier 10.1016/j.clinph.2020.10.021

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Forschungsbereich Mu50 > Forschungsgruppe Neurochirurgie

UniBE Contributor:

Seidel, Kathleen and Raabe, Andreas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1388-2457

Publisher:

Elsevier

Language:

English

Submitter:

Nicole Söll

Date Deposited:

12 Jan 2021 08:50

Last Modified:

14 Feb 2021 01:36

Publisher DOI:

10.1016/j.clinph.2020.10.021

PubMed ID:

33272821

Uncontrolled Keywords:

Brainstem Complications Neurophysiological monitoring Posterior fossa Surgery Tumor

BORIS DOI:

10.48350/149968

URI:

https://boris.unibe.ch/id/eprint/149968

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