Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, U.S.A.
Laryngoscope. 2020 Jul;130(7):1836-1843. doi: 10.1002/lary.28341. Epub 2019 Nov 19.
OBJECTIVES/HYPOTHESIS: Upper airway stimulation for obstructive sleep apnea (OSA) via implantable hypoglossal nerve stimulation (HGNS) reduces airway obstruction by selectively stimulating nerve fibers that innervate muscles that produce tongue protrusion, while avoiding fibers that produce tongue retraction. This selective stimulation likely depends upon the location, intensity, and type of electrical stimulation delivered. This study investigates the impact of changing stimulation parameters on tongue muscle activation during HGNS using intraoperative nerve integrity monitoring in conjunction with electromyography (EMG).
Prospective case series.
Ten patients undergoing unilateral HGNS implantation for OSA in a university hospital setting were studied. Data included EMG responses in tongue muscles that produce protrusion (genioglossus), retraction (styloglossus/hyoglossus), and stiffening (transverse/vertical) in response to intraoperative bipolar probe electrical stimulation of lateral and medial branches of the hypoglossal nerve (HGN) and to implantable pulse generator (IPG) unipolar and bipolar settings after placement of the stimulation cuff.
Stimulation of medial division HGN branches resulted in EMG responses in genioglossus muscles, but not in styloglossus/hyoglossus muscles, whereas stimulation of the lateral division HGN branches drove responses in styloglossus/hyoglossus muscles. Variable responses in transverse/vertical muscles were observed with stimulation of lateral and medial division branches. After electrode cuff placement, unipolar and bipolar HGN stimulation configurations of IPG resulted in unique patterns of muscle activation.
The relative activation of extrinsic and intrinsic tongue musculature by HGNS is determined by stimulus location, intensity, and type. Intraoperative neurophysiological monitoring of tongue muscle activation enables proper electrode cuff placement and may provide essential data for stimulus optimization.
4 Laryngoscope, 130:1836-1843, 2020.
目的/假设：通过植入式舌下神经刺激（HGNS）治疗阻塞性睡眠呼吸暂停（OSA），通过选择性刺激支配舌突出的神经纤维来减少气道阻塞，同时避免刺激引起舌回缩的纤维。这种选择性刺激可能取决于所施加的电刺激的位置、强度和类型。本研究通过术中神经完整性监测结合肌电图（EMG）来研究改变刺激参数对 HGNS 期间舌肌激活的影响。
前瞻性病例系列。
在一所大学医院环境中，对 10 例接受单侧 HGNS 植入治疗 OSA 的患者进行了研究。数据包括术中对舌下神经（HGN）外侧和内侧分支进行双极探针电刺激以及植入式脉冲发生器（IPG）单极和双极设置后，舌突出（颏舌肌）、回缩（舌骨舌肌/舌下肌）和僵硬（横/垂直）产生的舌肌 EMG 反应。
刺激舌下神经内侧分支会引起颏舌肌的 EMG 反应，但不会引起舌骨舌肌/舌下肌的反应，而刺激舌下神经外侧分支会引起舌骨舌肌/舌下肌的反应。刺激外侧和内侧分支时，观察到横/垂直肌肉的可变反应。放置电极袖带后，IPG 的单极和双极 HGN 刺激配置会导致肌肉激活的独特模式。
HGNS 对舌外肌和舌内肌的相对激活取决于刺激的位置、强度和类型。术中对舌肌激活的神经生理监测可以实现正确的电极袖带放置，并为刺激优化提供必要的数据。
4 级喉镜，130:1836-1843，2020 年。
