Department of Clinical Neurophysiology, King's College Hospital NHS Trust, London, UK.
Department of Intraoperative Neuromonitoring Mount Sinai West Hospital, New York City, USA.
Clin Neurophysiol. 2022 May;137:1-10. doi: 10.1016/j.clinph.2022.02.004. Epub 2022 Feb 16.
Brainstem trigeminal-hypoglossal reflexes (THRs), also known as the jaw-tongue reflexes, coordinate the position of the tongue in the mouth in relation to the jaw movement during oromotor behaviors such as mastication, swallowing, vocalization, and breathing. Their use in brainstem surgery however, has never been assessed in spite of its potential benefit possibly due to the lack of a methodology to elicit these reflexes under general anesthesia.
We proposed a technique to elicit the THRs during total intravenous anesthesia (TIVA) consisting on a V3 infrazygomatic train stimulation paradigm and recording from the Styloglossus (31 patients) and the Genioglossus (21 patients) muscles to elicit long latency responses.
The THR was successfully recorded using the V3 stimulation point in 82.1% of patients, of which 96.9% presented a response on the Styloglossus muscle (Jaw-opening reflex) while 0.06% presented a response on the Genioglossus muscle instead (Jaw-closing reflex).
The THRs can be successfully recorded in surgery under general anaesthesia with the predominant reflex seen being the jaw-opening reflex.
We provide a novel method to elicit the THRs during general anesthesia, which could be of aid in brainstem surgery.
脑干三叉神经舌下反射（THR），也称为下颌舌反射，在咀嚼、吞咽、发声和呼吸等口运动行为中协调舌在口腔中的位置与下颌运动的关系。然而，尽管其可能具有潜在益处，但由于缺乏在全身麻醉下引出这些反射的方法，因此从未在脑干手术中评估其用途。
我们提出了一种在全静脉麻醉（TIVA）下引出 THR 的技术，包括 V3 眶下刺激范式和记录 Styloglossus（31 例）和 Genioglossus（21 例）肌肉以引出长潜伏期反应。
使用 V3 刺激点成功记录了 82.1%的患者的 THR，其中 96.9%的患者在 Styloglossus 肌肉（张口反射）上出现反应，而 0.06%的患者在 Genioglossus 肌肉（闭口反射）上出现反应。
在全身麻醉下的手术中可以成功记录 THR，主要观察到的反射是张口反射。
我们提供了一种在全身麻醉下引出 THR 的新方法，这可能有助于脑干手术。
