Our Summary

This research paper is about a study that tested a new technique to protect the 10th cranial nerve (also known as the vagus nerve) during certain types of brain surgery. The vagus nerve can be damaged during surgery in a particular area of the brain called the lower cerebellopontine angle. This can cause complications like difficulty swallowing and hoarseness.

The researchers used a special kind of electrode, placed in the patient’s windpipe (endotracheal surface electrodes), to measure the activity of the vagus nerve during surgery. This could help surgeons to avoid damaging the nerve.

The study involved 20 patients. The researchers were able to use the electrodes successfully in 17 of them. The other three patients’ data couldn’t be used for various reasons. Out of the 17, 14 had brain tumors and 3 had other issues needing surgery.

In 12 patients, the researchers were able to record nerve activity from both the endotracheal electrodes and from needle electrodes placed in the soft palate (the back part of the roof of the mouth). This was especially the case in patients where the nerve was close to the tumor.

The researchers found that there was a lot of difference between individuals in terms of the nerve activity they recorded, but within each individual the measurements were fairly consistent. They also found that they couldn’t predict the nerve activity based on the type of surgery or the position of the vagus nerve.

In two patients, the vagus nerve activity disappeared during surgery, which was linked to difficulties swallowing and hoarseness after the operation for one of them.

The researchers concluded that the endotracheal electrodes can be useful for identifying and protecting the vagus nerve during brain surgery. They believe this technique could be beneficial in certain patients where there is a risk to the vagus nerve.

FAQs

  1. What are endotracheal surface electrodes and how are they used during CPA surgery?
  2. How reliable are endotracheal surface electrodes for the assessment of CN X motor function during CPA surgery?
  3. Can the use of endotracheal surface electrodes during CPA surgery help in identifying potential risks to the vagus nerve?

Doctor’s Tip

A doctor may advise a patient undergoing vocal cord surgery to follow post-operative care instructions carefully, including voice rest and avoiding excessive talking or shouting. It is important to attend all follow-up appointments and voice therapy sessions to ensure proper healing and recovery of vocal function. Additionally, maintaining good hydration and avoiding irritants such as smoking or excessive alcohol consumption can help promote healing of the vocal cords.

Suitable For

Patients who are typically recommended vocal cord surgery are those with tumors or nontumor pathologies in the lower cerebellopontine angle (CPA) that may put the 10th cranial nerve (CN X) at risk during surgery. Additionally, patients with an intricate relationship between lower cranial nerves and tumor formations may benefit from vocal cord surgery to prevent potential nerve damage and postoperative complications such as dysphagia and hoarseness. These patients may undergo evaluation with endotracheal surface electrodes to assess CN X motor function and identify any potential risks during surgery.

Timeline

Before vocal cord surgery:

  1. Patient presents with symptoms such as hoarseness, difficulty swallowing, or changes in voice quality.
  2. Patient undergoes evaluation by an otolaryngologist, including a physical examination and possibly imaging studies such as a laryngoscopy or MRI.
  3. Otolaryngologist determines that vocal cord surgery is necessary to address the underlying issue.
  4. Patient is scheduled for surgery and receives preoperative instructions.

After vocal cord surgery:

  1. Patient undergoes vocal cord surgery, which may involve tumor removal or other procedures to improve vocal cord function.
  2. During surgery, endotracheal surface electrodes are used to monitor the function of the 10th cranial nerve (CN X) and assess vocal cord motor function.
  3. Postoperatively, patient may experience temporary hoarseness, sore throat, or difficulty swallowing as they recover from the surgery.
  4. Patient is monitored closely for any complications or changes in vocal cord function.
  5. Follow-up appointments are scheduled to assess the success of the surgery and address any ongoing issues with vocal cord function.

What to Ask Your Doctor

  1. What is the purpose of vocal cord surgery in my case?
  2. What are the potential risks and complications associated with vocal cord surgery?
  3. How will the surgery affect my ability to speak and swallow?
  4. What is the expected recovery time and rehabilitation process after vocal cord surgery?
  5. How will the surgery impact my overall quality of life and daily activities?
  6. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  7. How experienced are you in performing vocal cord surgery, and what is your success rate?
  8. Will I need any follow-up appointments or additional treatments after the surgery?
  9. What can I do to prepare for the surgery and optimize my chances of a successful outcome?
  10. How will I know if the surgery has been successful in improving my vocal cord function?

Reference

Authors: Romagna A, Rachinger W, Schwartz C, Mehrkens JH, Betz C, Briegel J, Schnell O, Tonn JC, Schichor C, Thon N. Journal: Neurosurgery. 2015 Sep;77(3):471-8; discussion 478. doi: 10.1227/NEU.0000000000000854. PMID: 26103443