Noninvasive, tube‐based, continuous vagal nerve monitoring using the laryngeal adductor reflex: Feasibility study of 134 nerves at risk

Sinclair, Catherine F.; Téllez, María J.; Ulkatan, Sedat

doi:10.1002/hed.25377

Cited by 49 publications

(55 citation statements)

References 25 publications

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“…For detailed methodology of LAR‐CIONM for vagal and RLN motor fibers, please refer to prior publications on this topic . For LAR‐CIONM of sensory nerve fibers, the methodology varies somewhat because the LAR is elicited by ETT electrode stimulation of supraglottic mucosa ipsilateral to the IBSLN at risk and is recorded from the contralatera l vocal fold supplied by RLN motor fibers not at risk running in the contralateral neck.…”

Section: Methodsmentioning

confidence: 99%

“…In 2017, a novel methodology was introduced to continuously monitor vagal and RLN motor fibers using the laryngeal adductor reflex (LAR), termed LAR‐CIONM . The LAR is a brainstem reflex initiated by supraglottic irritation.…”

Section: Introductionmentioning

confidence: 99%

“…Afferent information is carried by the internal branch of the superior laryngeal nerve (IBSLN) to the medulla oblongata, with motor fibers of the vagus nerve (via the RLN) activating laryngeal adductor musculature to initiate vocal fold contraction and airway protection. Previous publications have reported on the utility of this technique for continuously monitoring vagus nerve motor fibers during neck endocrine, cervical spine, and lower brainstem procedures . Due to the anatomical separation of afferent and efferent limbs of the reflex, it was hypothesized that mapping and monitoring of vagus nerve sensory fibers may also be possible using the LAR.…”

Section: Introductionmentioning

confidence: 99%

“…In 2017, a novel methodology was introduced to continuously monitor vagal and RLN motor fibers using the laryngeal adductor reflex (LAR), termed LAR-CIONM. [1][2][3] The LAR is a brainstem reflex initiated by supraglottic irritation. Afferent information is carried by the internal branch of the superior laryngeal nerve (IBSLN) to the medulla oblongata, with motor fibers of the vagus nerve (via the RLN) activating laryngeal adductor musculature to initiate vocal fold contraction and airway protection.…”

Section: Introductionmentioning

confidence: 99%

“…Previous publications have reported on the utility of this technique for continuously monitoring vagus nerve motor fibers during neck endocrine, cervical spine, and lower brainstem procedures. 1,2,4,5 Due to the anatomical separation of afferent and efferent limbs of the reflex, it was hypothesized that mapping and monitoring of vagus nerve sensory fibers may also be possible using the LAR.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Intraoperative mapping and monitoring of sensory vagal fibers during vagal schwannoma resection

Sinclair¹,

Téllez²,

Roldán³

et al. 2019

The Laryngoscope

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Vagal schwannomas are rare, benign tumors. Intermittent intraoperative neuromonitoring via selective stimulation of splayed motor fibers running on the schwannoma surface to elicit a compound muscle action potential has been previously reported as a method of preserving vagal motor fibers. In this case report, vagal sensory fibers are mapped and continuously monitored intraoperatively during high vagus schwannoma resection using the laryngeal adductor reflex (LAR). Mapping of nerve fibers on the schwannoma surface enabled identification of sensory fibers. Continuous LAR monitoring during schwannoma subcapsular microsurgical dissection enabled sensory (and motor) vagal fibers to be monitored in real time with excellent postoperative functional outcomes. Laryngoscope, 129:E434–E436, 2019

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Intraoperative mapping and monitoring of sensory vagal fibers during vagal schwannoma resection

Sinclair¹,

Téllez²,

Roldán³

et al. 2019

The Laryngoscope

Self Cite

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Vagal schwannomas of the head and neck: A comprehensive review and a novel approach to preserving vocal cord innervation and function

et al. 2019

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Background: Schwannomas, benign tumors arising from neurolemmocytes, are the most common type of peripheral nerve tumors. Extracranial schwannomas are most often found in the parapharyngeal space, commonly involving the vagus nerve to cervical sympathetic trunk. Vagal schwannomas present several unique clinical and therapeutic challenges. Methods: A comprehensive literature review was conducted on 197 articles reporting 235 cases of cervical vagal schwannomas. Presenting symptoms, treatment approach, and postoperative outcomes were recorded and analyzed. Results: Vagal schwannomas commonly present as asymptomatic neck masses. When they become symptomatic, surgical resection is the standard of care. Gross total resection is associated with higher postoperative morbidity compared to subtotal resection. Initial reports using intraoperative nerve monitoring have shown improved nerve preservation. Recurrence rates are low. Conclusion: The combination of intermittent nerve mapping with novel continuous vagal nerve monitoring techniques may reduce postoperative morbidity and could represent the future standard of care for vagal schwannoma treatment. K E Y W O R D S continuous intraoperative nerve monitoring, nerve sheath tumor, neurilemmoma, vagal schwannoma, vagus nerve

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A novel approach to neurologic function sparing surgical management of vagal schwannomas: Continuous intraoperative nerve monitoring of the laryngeal adductor reflex

et al. 2019

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Background Vagal schwannomas are rare, benign tumors of the head and neck. Nerve damage during surgical resection is associated with significant morbidity. A new technique of continuous intraoperative nerve monitoring (IONM) that allows for real‐time intraoperative feedback has recently been used for thyroid and cervical spine surgeries but has not previously been used in vagal schwannoma surgery. Methods Case series of three patients who underwent vagal schwannoma excision utilizing this novel IONM technique. The recurrent laryngeal and vagus nerves were monitored via the laryngeal adductor reflex (LAR) using an electromyographic endotracheal tube. Results Three patients with suspected vagal schwannomas were treated surgically using the intracapsular enucleation approach with a combination of intermittent IONM and continuous IONM of the LAR. Conclusion This combination of continuous and intermittent IONM can be used to preserve vagal laryngeal innervation and function and may represent the future standard of care for vagal schwannoma excision.

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Noninvasive, tube‐based, continuous vagal nerve monitoring using the laryngeal adductor reflex: Feasibility study of 134 nerves at risk

Abstract: The LAR-C-IONM is a promising new way to perform continuous vagal monitoring that requires no equipment other than an electromyography (EMG) endotracheal tube and is undergoing further, large-scale evaluation.

Cited by 49 publications

References 25 publications

Intraoperative mapping and monitoring of sensory vagal fibers during vagal schwannoma resection

Intraoperative mapping and monitoring of sensory vagal fibers during vagal schwannoma resection

Vagal schwannomas of the head and neck: A comprehensive review and a novel approach to preserving vocal cord innervation and function

A novel approach to neurologic function sparing surgical management of vagal schwannomas: Continuous intraoperative nerve monitoring of the laryngeal adductor reflex

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