Taha J M, Tew J M, Keith R W, Payner T D
Department of Neurosurgery, University of Cincinnati College of Medicine, Ohio.
Neurosurgery. 1994 Oct;35(4):775-7. doi: 10.1227/00006123-199410000-00032.
Intracranial section of the glossopharyngeal and upper vagal rootlets for the treatment of vagoglossopharyngeal neuralgia may cause dysphagia or vocal cord paralysis from injury to the motor vagal rootlets in 10% to 20% of cases. To minimize this complication, we recently applied a technique of intraoperative monitoring of the vagus nerve (previously described by Lipton and McCaffery to monitor the recurrent laryngeal nerve during thyroid surgery) in a patient undergoing intracranial rhizotomy for vagoglossopharyngeal neuralgia. By inserting an electrode in the ipsilateral false vocal cord and stimulating the rostral vagal rootlets intraoperatively under general anesthesia, we could differentiate the rostral vagal motor rootlets from the sensory rootlets. In this patient, the technique allowed us to preserve a rostral vagal rootlet, which if sectioned, could have caused dysphagia or vocal cord paralysis. We conclude that intraoperative monitoring of the rostral vagal rootlets is an important technique to minimize complications of upper vagal rhizotomy.
舌咽神经和迷走神经上部神经根的颅内部分切断术用于治疗迷走舌咽神经痛时，在10%至20%的病例中，可能会因损伤迷走神经运动神经根而导致吞咽困难或声带麻痹。为了将这种并发症降至最低，我们最近在一名接受颅内神经根切断术治疗迷走舌咽神经痛的患者中应用了一种术中监测迷走神经的技术（此前Lipton和McCaffery曾描述过该技术用于在甲状腺手术中监测喉返神经）。通过在同侧假声带插入电极，并在全身麻醉下术中刺激迷走神经上部神经根，我们能够区分迷走神经上部运动神经根和感觉神经根。在该患者中，这项技术使我们能够保留一条迷走神经上部神经根，若将其切断可能会导致吞咽困难或声带麻痹。我们得出结论，术中监测迷走神经上部神经根是将迷走神经上部神经根切断术并发症降至最低的一项重要技术。
