Endotracheal Tube Electrodes to Assess Vocal Cord Motor Function During Surgery in the Cerebellopontine Angle

Neurosurgery ◽  
2015 ◽  
Vol 77 (3) ◽  
pp. 471-478
Author(s):  
Alexander Romagna ◽  
Walter Rachinger ◽  
Christoph Schwartz ◽  
Jan-Hinnerk Mehrkens ◽  
Christian Betz ◽  
...  
Keyword(s):  
At Risk ◽  
Vocal Cord ◽  
Motor Function ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Motor Action ◽  
Surface Electrodes ◽  
Electrophysiological Recordings ◽  
Bipolar Stimulation ◽  
Lower Cranial Nerves

AbstractBACKGROUND:The 10th cranial nerve (CN X) is at risk during surgery in the lower cerebellopontine angle (CPA).OBJECTIVE:To evaluate endotracheal surface electrodes for assessment of CN X motor function during CPA surgery.METHODS:Twenty patients were enrolled. Electrophysiological recordings were analyzed and retrospectively correlated with clinical, imaging, and intraoperative data.RESULTS:Recordings from endotracheal surface electrodes were reliable and eligible for analyses in 17 patients; in 3 patients, no surface electrode compound motor action potentials (CMAPs) could be obtained. Those patients with sufficient recordings underwent surgery in the CPA for tumors in 14 patients and for nontumor pathologies in 3 patients. In 12 patients, bipolar stimulation of motor rootlets in the CPA resulted in simultaneous CMAPs recorded from both surface electrodes and needle electrodes placed in the soft palate. Coactivation was particularly seen in patients with an intricate relationship between lower cranial nerves and tumor formations (n = 9/10). Amplitudes and latencies of vocal cord CMAPs showed high interindividual but low intraindividual variability. Parameters were not well correlated with the type of surgery (tumor vs nontumor surgery) and lower CN anatomy (displaced vs undisplaced). In 2 patients, vocal cord CMAPs were lost during tumor surgery, which was associated with postoperative dysphagia and hoarseness in 1 patient.CONCLUSION:Endotracheal surface electrodes allow identification of vocal cord motor rootlets in the CPA. Worsening of CMAP parameters might indicate functional impairment. These aspects support the use of endotracheal surface electrodes in selected patients in whom the vagus nerve might be at risk during CPA surgery.

Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery

2000 ◽  
Vol 93 (4) ◽  
pp. 586-593 ◽  
Author(s):  
Johann Romstöck ◽  
Christian Strauss ◽  
Rudolf Fahlbusch
Keyword(s):  
Detailed Analysis ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Operative Procedure ◽  
Cranial Nerves ◽  
Postoperative Outcome ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Lower Cranial Nerves ◽  
Fine Print

Object. Electromyography (EMG) monitoring is expected to reduce the incidence of motor cranial nerve deficits in cerebellopontine angle surgery. The aim of this study was to provide a detailed analysis of intraoperative EMG phenomena with respect to their surgical significance.Methods. Using a system that continuously records facial and lower cranial nerve EMG signals during the entire operative procedure, the authors examined 30 patients undergoing surgery on acoustic neuroma (24 patients) or meningioma (six patients). Free-running EMG signals were recorded from muscles targeted by the facial, trigeminal, and lower cranial nerves, and were analyzed off-line with respect to waveform characteristics, frequencies, and amplitudes. Intraoperative measurements were correlated with typical surgical maneuvers and postoperative outcomes.Characteristic EMG discharges were obtained: spikes and bursts were recorded immediately following the direct manipulation of a dissecting instrument near the cranial nerve, but also during periods when the nerve had not yet been exposed. Bursts could be precisely attributed to contact activity. Three distinct types of trains were identified: A, B, and C trains. Whereas B and C trains are irrelevant with respect to postoperative outcome, the A train—a sinusoidal, symmetrical sequence of high-frequency and low-amplitude signals—was observed in 19 patients and could be well correlated with additional postoperative facial nerve paresis (in 18 patients).Conclusions. It could be demonstrated that the occurrence of A trains is a highly reliable predictor for postoperative facial palsy. Although some degree of functional worsening is to be expected postoperatively, there is a good chance of avoiding major deficits by warning the surgeon early. Continuous EMG monitoring is superior to electrical nerve stimulation or acoustic loudspeaker monitoring alone. The detailed analysis of EMG-waveform characteristics is able to provide more accurate warning criteria during surgery.

Continuous Laryngoscopic Vocal Cord Monitoring for Vascular Malformation Surgery in the Medulla Oblongata: Technical Note

Neurosurgery ◽  
2004 ◽  
Vol 54 (1) ◽  
pp. 232-235 ◽  
Author(s):  
Yoshinori Tamano ◽  
Hiroshi Ujiie ◽  
Takakazu Kawamata ◽  
Tomokatsu Hori
Keyword(s):  
Postoperative Complications ◽  
Evoked Potentials ◽  
Vocal Cord ◽  
Medulla Oblongata ◽  
Fourth Ventricle ◽  
Cranial Nerves ◽  
Posterior Pharyngeal Wall ◽  
Spontaneous Respiration ◽  
Pharyngeal Wall ◽  
Lower Cranial Nerves

Abstract OBJECTIVE Resection of lesions located in the medulla oblongata may result in significant morbidity. The most lethal complications are swallowing disturbances, which can lead to aspiration pneumonia. To prevent this problem, the lower cranial nerves can be mapped with recording needles placed in the posterior pharyngeal wall and the tongue. However, mapping alone is not sufficient to preserve the lower cranial nerves and swallowing functions. To overcome this problem, we attempted to devise a method to intraoperatively monitor vocal cord movements with a laryngoscope. We used this method, in addition to other types of brainstem mapping, in three cases. METHODS Recording needles were inserted into the posterior pharyngeal wall and the tongue, to record the responses of Cranial Nerves IX and XII. A laryngoscope was inserted orally, for direct observation of vocal cord movements, and was maintained until the end of the operation. The floor of the fourth ventricle was stimulated with a monopolar stimulator. Somatosensory evoked potentials, auditory evoked potentials, and motor evoked potentials were simultaneously monitored. RESULTS We were able to confirm synchronized vocal cord adduction with stimulation of the expected vagal trigonum location and to monitor rhythmic vocal cord movements during spontaneous respiration. In all three cases, we removed the lesions without postoperative complications. CONCLUSION In addition to intraoperative vocal cord monitoring with a laryngoscope, we could safely determine the optimal location for the first incision in the floor of the fourth ventricle. Potentially lethal postoperative complications can be avoided with brainstem mapping and vocal cord monitoring.

Intraoperative Mapping and Monitoring for Rootlets of the Lower Cranial Nerves Related to Vocal Cord Movement

Neurosurgery ◽  
2015 ◽  
Vol 78 (6) ◽  
pp. 829-834 ◽  
Author(s):  
Masahiko Wanibuchi ◽  
Yukinori Akiyama ◽  
Takeshi Mikami ◽  
Katsuya Komatsu ◽  
Toshiya Sugino ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Vocal Cord ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Visual Signals ◽  
Electromyographic Activity ◽  
Intraoperative Mapping ◽  
Lower Cranial Nerves ◽  
Risk Of Aspiration ◽  
Functional Preservation

Abstract BACKGROUND: Damage to the motor division of the lower cranial nerves that run into the jugular foramen leads to hoarseness, dysphagia, and the risk of aspiration pneumonia; therefore, its functional preservation during surgical procedures is important. Intraoperative mapping and monitoring of the motor rootlets at the cerebellomedullary cistern using endotracheal tube electrodes is a safe and effective procedure to prevent its injury. OBJECTIVE: To study the location of the somatic and autonomic motor fibers of the lower cranial nerves related to vocal cord movement. METHODS: Twenty-four patients with pathologies at the cerebellopontine lesion were studied. General anesthesia was maintained with fentanyl and propofol. A monopolar stimulator was used at amplitudes of 0.05 to 0.1 mA. Both acoustic and visual signals were displayed as vocalis muscle electromyographic activity using endotracheal tube surface electrodes. RESULTS: The average number of rootlets was 7.4 (range, 5-10); 75% of patients had 7 or 8 rootlets. As many as 6 rootlets (2-4 in most cases) were responsive in each patient. In 23 of the 24 patients, the responding rootlets congregated on the caudal side. The maximum electromyographic response was predominantly in the most caudal or second most caudal rootlet in 79%. CONCLUSION: The majority of motor fibers of the lower cranial nerves run through the caudal part of the rootlets at the cerebellomedullary cistern, and the maximal electromyographic response was elicited at the most caudal or second most caudal rootlet.

scholarly journals Microsurgical Resection of Cerebellopontine Angle Choroid Plexus Papilloma by Far-Lateral Approach. Case Report

2018 ◽  
Vol 28 (3) ◽  
pp. 193-196
Author(s):  
Lucas Crociati Meguins ◽  
Dionei Freitas De Morais ◽  
Carlos Eduardo Dall’Aglio Rocha ◽  
Ricardo Lourenço Caramanti ◽  
Thayanna Bentes Lemanski Lopes Rodrigues ◽  
...  
Keyword(s):  
Case Report ◽  
Choroid Plexus ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Choroid Plexus Papilloma ◽  
Lateral Approach ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Lower Cranial Nerves ◽  
Plexus Papilloma

Introduction: Choroid plexus tumors (CPTs) are rare papillary neoplasms derived from choroid plexus epithelium. They account for only approximately 0.4%-0.6% of all intracranial tumors, but 10%-20% of brain tumors occurring throughout the first year of life. Objective: The present study describes the case of an adult man presenting a cerebellopontine angle choroid plexus papilloma (CPP) microsurgically treated through suboccipital far-lateral approach. Case report: A 67-years-old-man was admitted presenting progressive headaches and left lower limb weakness. Magnetic resonance images showed a large tumor on the left cerebellopontine angle with heterogeneous contrast enhancement. Total surgical resection was achieved through a right suboccipital far-lateral craniotomy on lateral position with neurophysiological monitoring of lower cranial nerves. No alterations on cranial nerves function was observed during tumor resection. The patient presented an uneventful recovery and was discharged home on the fifth post-operative day. On the six months follow-up, he was asymptomatic. Anatomopathological analysis confirmed the diagnosis of CPP, WHO grade I. Conclusion: Cerebellopontine angle’s cpp is an extremely rare neoplasm that challenges a neurosurgeon ability to deal with tumor in close relation to lower cranial nerves. Appropriate neurosurgical route, surgeons experience and adequate anatomical knowledge of important neural and vascular structures are fundamental to safely remove CPP of the posterior fossa. Suboccipital far-lateral craniotomy gives enough view with minimal retraction to manage the tumor.

Cerebellopontine angle metastasis from clear-cell renal carcinoma presenting as bleeding from the ear

1996 ◽  
Vol 110 (4) ◽  
pp. 370-372 ◽  
Author(s):  
H. S. Bhatoe ◽  
G. U. Deshpande
Keyword(s):  
Cerebellopontine Angle ◽  
Renal Carcinoma ◽  
Clear Cell ◽  
Cranial Nerves ◽  
Metastatic Lesion ◽  
Clear Cell Renal Carcinoma ◽  
Clinical Appearance ◽  
Metastatic Lesions ◽  
Cell Renal Carcinoma ◽  
Lower Cranial Nerves

AbstractMetastatic lesions in the cerebellopontine angle are rare. We encountered one such metastatic lesion from clearcell renal carcinoma that had a striking clinical appearance, bleeding from the ear and multiple lower cranial nerves' involvement. While the overall prognosis in CNS metastasis from systemic malignancy is gloomy, useful palliation can be achieved in patients with solitary lesions.

scholarly journals Extra-axial cerebellopontine angle cavernoma: A case report and review of literature

2020 ◽  
Vol 11 ◽  
pp. 386
Author(s):  
Bashar Abuzayed ◽  
Anas Said ◽  
Osama Jamous ◽  
Omar Al-Ashqar ◽  
Hussein Al-Abadi ◽  
...  
Keyword(s):  
Cerebellopontine Angle ◽  
Histopathological Examination ◽  
Cranial Nerves ◽  
Downbeat Nystagmus ◽  
Hemosiderin Deposition ◽  
Intraoperative Management ◽  
Level Of Consciousness ◽  
Axial Mass ◽  
The Right ◽  
Lower Cranial Nerves

Background: Extra-axial cavernomas at the cerebellopontine angle (CPA) are rare clinical entity that can radiologically mimic several lesions encountered at this location. Case Description: A 36-year-old female patient referred to our emergency service with acute decreased level of consciousness and vomiting. Neurological examination showed Glasgow Coma Scale of 12 with downbeat nystagmus of the right eye. Brain computed tomography scan and magnetic resonance imaging showed multilobulated extra-axial mass lesion located in the right CPA. The lesion was with various signal intensities in T1- and T2-weighted images suggestive of hemorrhages of different ages. T2 gradient echo sequences showed multiple sinusoid-like channels and diffuse hemosiderin deposition. These figures were compatible with cavernous malformation. The patient was operated by retrosigmoid approach. Dissection of the mass from the trigeminal, facial, vestibulocochlear, and lower cranial nerves was performed and total resection of the tumor was achieved. Histopathological examination confirmed the diagnosis of cavernoma. Conclusion: Although CPA cavernomas are very rare, they should be considered for differential diagnosis when evaluating CPA lesions preoperatively for better intraoperative management and postoperative outcomes.

Endonasal access to lower cranial nerves: From foramina to upper parapharyngeal space

Head & Neck ◽  
2021 ◽  
Author(s):  
Lifeng Li ◽  
Nyall R. London ◽  
Daniel M. Prevedello ◽  
Ricardo L. Carrau
Keyword(s):  
Parapharyngeal Space ◽  
Cranial Nerves ◽  
Lower Cranial Nerves
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