神经监测引导下的阻塞性睡眠呼吸暂停患者选择性舌下神经刺激
Nerve monitoring-guided selective hypoglossal nerve stimulation in obstructive sleep apnea patients.
作者信息
Heiser Clemens, Hofauer Benedikt, Lozier Luke, Woodson B Tucker, Stark Thomas
机构信息
Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität München, Munich, Germany.
Inspire Medical Systems, Maple Grove, Minnesota.
出版信息
Laryngoscope. 2016 Dec;126(12):2852-2858. doi: 10.1002/lary.26026. Epub 2016 Jun 27.
OBJECTIVE/HYPOTHESIS: Selective stimulation of the upper airway is a new therapy for obstructive sleep apnea. The aim of the study was to determine if a selective nerve integrity monitoring (NIM) system could aid in precise placement of the cuff electrode in selective upper-airway stimulation.
STUDY DESIGN
Single-center, prospective clinical trial.
METHODS
Twenty patients who received a selective upper-airway stimulation system (Inspire Medical Systems, Maple Grove, MN) were implanted by using a NIM system. The tongue motions were recorded during surgery and 2 months postoperatively from the transoral view and by transnasal endoscopy.
RESULTS
All patients exhibited consistent protrusion at tongue front and tongue base. The nerve monitoring system helped to place the cuff electrode around the protrusion and stiffening branches, while excluding the retractor branches of the hypoglossal nerve.
CONCLUSION
This report demonstrated a novel use of a NIM system to identify the functional separation between inclusion and exclusion branches of the hypoglossal nerve for implantation of a selective upper-airway stimulation system.
LEVEL OF EVIDENCE
- Laryngoscope, 126:2852-2858, 2016.
目的/假设：对上气道进行选择性刺激是治疗阻塞性睡眠呼吸暂停的一种新疗法。本研究的目的是确定选择性神经完整性监测（NIM）系统是否有助于在选择性上气道刺激中精确放置袖带电极。
研究设计
单中心前瞻性临床试验。
方法
20例接受选择性上气道刺激系统（Inspire Medical Systems，明尼苏达州枫树谷）的患者通过使用NIM系统进行植入。在手术期间及术后2个月，从经口视图和经鼻内窥镜检查记录舌运动。
结果
所有患者舌前部和舌基部均表现出一致的前突。神经监测系统有助于将袖带电极放置在前突和变硬分支周围，同时排除舌下神经的牵开器分支。
结论
本报告展示了NIM系统的一种新用途，即识别舌下神经包含和排除分支之间的功能分离，以植入选择性上气道刺激系统。
证据水平
4。《喉镜》，126:2852 - 2858，2016年。
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