Akiyama Tomoaki, Tanaka Shunya, Hitotsumatsu Tsutomu
Department of Neurosurgery, Stroke and Neurological Center, Shin-Koga Hospital, Kurume, Fukuoka, Japan.
NMC Case Rep J. 2021 Apr 2;8(1):45-50. doi: 10.2176/nmccrj.cr.2019-0283. eCollection 2021 Apr.
Cardiovascular malformations during embryogenesis can lead the inferior laryngeal nerve to branching directly from the cervical vagus nerve and entering the larynx. This rare anatomical variation is known as a non-recurrent inferior laryngeal nerve (NRILN), and increases the risk of accidental injury resulting in postoperative vocal cord paralysis during neck surgery. We report a case of an 83-year-old man who presented with left symptomatic internal carotid artery stenosis with a right-sided aortic arch and aberrant left subclavian artery (ALSCA). We performed carotid endarterectomy (CEA) using intraoperative neuromonitoring to avoid NRILN injury. To the best of our knowledge, this is the first report of searching for a left NRILN by electrophysiology during CEA. Neurovascular surgeons need to understand the variations of the NRILN associated with congenital cardiovascular anomalies and effective use of intraoperative nerve monitoring (IONM). We discuss the embryological origin, IONM, and surgical pitfalls of this case.
胚胎发育过程中的心血管畸形可导致喉返神经直接从颈迷走神经分支并进入喉部。这种罕见的解剖变异被称为非喉返神经（NRILN），会增加颈部手术期间意外损伤导致术后声带麻痹的风险。我们报告了一例83岁男性患者，其表现为左侧有症状的颈内动脉狭窄，伴有右侧主动脉弓和异常的左侧锁骨下动脉（ALSCA）。我们在术中神经监测的辅助下进行了颈动脉内膜切除术（CEA），以避免NRILN损伤。据我们所知，这是第一例在CEA期间通过电生理学寻找左侧NRILN的报告。神经血管外科医生需要了解与先天性心血管异常相关的NRILN变异情况，并有效利用术中神经监测（IONM）。我们讨论了该病例的胚胎学起源、IONM及手术陷阱。
