Fontana V, Squintani G M, Badari A, Basaldella F, Sala F, Pinna G, Masotto B
Department of Neurosciences, Biomedicine and Movement Sciences, Posterior Cranial Fossa Surgery Unit, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, Verona, Veneto, 37126, Italy.
Division of Neurology, Azienda Ospedaliera Universitaria Integrata Verona Verona, Veneto, Italy.
Neurol Sci. 2025 Jul 14. doi: 10.1007/s10072-025-08359-5.
Intractable hiccups, although typically benign, occasionally present as a clinical challenge requiring deeper investigation. We report a case of persistent hiccups as the sole manifestation of a cystic hemangioblastoma within the medulla oblongata. Conventional hiccup treatments were ineffective, prompting surgical intervention. We employed intraoperative neurophysiological monitoring of the Laryngeal Adductor Reflex (LAR) during the procedure, revealing intriguing asymmetries in reflex responses. At the end of the surgical excision, we recorded a significant LAR decrease on the left side, without any changes in vocal corticobulbar potentials (vocal coMEPs). Postoperatively, the patient's hiccups ceased, leaving transient pharyngeal hypoesthesia. This case underscores the utility of LAR monitoring and vocal coMEPs in brainstem surgeries and discuss a potential link between post-surgical LAR reduction, and hiccup resolution. Our findings prompt further exploration of the complex neural mechanisms governing hiccups and their therapeutic implications in neurosurgery.
顽固性呃逆虽然通常是良性的，但偶尔也会成为需要深入调查的临床挑战。我们报告一例持续性呃逆作为延髓内囊性血管母细胞瘤的唯一表现。传统的呃逆治疗无效，促使进行手术干预。我们在手术过程中对喉内收肌反射（LAR）进行了术中神经生理监测，发现反射反应存在有趣的不对称性。手术切除结束时，我们记录到左侧LAR显著下降，而皮质延髓发声电位（vocal coMEPs）没有任何变化。术后，患者的呃逆停止，遗留短暂的咽部感觉减退。本病例强调了LAR监测和vocal coMEPs在脑干手术中的作用，并讨论了术后LAR降低与呃逆缓解之间的潜在联系。我们的发现促使进一步探索控制呃逆的复杂神经机制及其在神经外科中的治疗意义。
