TY - JOUR
T1 - Insertion of intra-oral electrodes for cranial nerve monitoring using a Crowe–Davis retractor
AU - Trentman, Terrence L.
AU - Thunberg, Christopher
AU - Gorlin, Andrew
AU - Koht, Antoun
AU - Zimmerman, Richard S.
AU - Bendok, Bernard
N1 - Publisher Copyright:
© 2016, The Author(s).
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Acoustic neuroma resection is an example of a neurosurgical procedure where the brainstem and multiple cranial nerves are at risk for injury. Electrode placement for monitoring of the glossopharyngeal and hypoglossal nerves during acoustic neuroma resection can be challenging. The purpose of this report is to illustrate the use of a device for intra-oral electrode placement for intraoperative monitoring of the glossopharyngeal and hypoglossal nerves. A 60-year-old male presented for acoustic neuroma resection. Under general anesthesia, a Crowe–Davis retractor was used to open the mouth, providing access to the posterior pharynx. For glossopharyngeal monitoring, two bent subdermal needle electrodes were inserted just lateral to the uvula. Two additional electrodes were inserted on the lateral tongue to monitor the hypoglossal nerve. Cranial nerves monitoring was conducted utilizing both free running and triggered electromyography of the trigeminal and facial nerves in addition to the lower cranial nerves. The tumor was resected successfully. Monitoring of the cranial nerves (including the glossopharyngeal and hypoglossal nerves) revealed no concerning responses. The Crowe–Davis retractor and the technique described allowed insertion of electrodes for neural monitoring, contributing to neural preservation.
AB - Acoustic neuroma resection is an example of a neurosurgical procedure where the brainstem and multiple cranial nerves are at risk for injury. Electrode placement for monitoring of the glossopharyngeal and hypoglossal nerves during acoustic neuroma resection can be challenging. The purpose of this report is to illustrate the use of a device for intra-oral electrode placement for intraoperative monitoring of the glossopharyngeal and hypoglossal nerves. A 60-year-old male presented for acoustic neuroma resection. Under general anesthesia, a Crowe–Davis retractor was used to open the mouth, providing access to the posterior pharynx. For glossopharyngeal monitoring, two bent subdermal needle electrodes were inserted just lateral to the uvula. Two additional electrodes were inserted on the lateral tongue to monitor the hypoglossal nerve. Cranial nerves monitoring was conducted utilizing both free running and triggered electromyography of the trigeminal and facial nerves in addition to the lower cranial nerves. The tumor was resected successfully. Monitoring of the cranial nerves (including the glossopharyngeal and hypoglossal nerves) revealed no concerning responses. The Crowe–Davis retractor and the technique described allowed insertion of electrodes for neural monitoring, contributing to neural preservation.
KW - Acoustic neuroma
KW - Bulbar palsy
KW - Cranial nerve monitoring
KW - Glossopharyngeal nerve
KW - Hypoglossal nerve
UR - http://www.scopus.com/inward/record.url?scp=84977111953&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84977111953&partnerID=8YFLogxK
U2 - 10.1007/s10877-016-9904-y
DO - 10.1007/s10877-016-9904-y
M3 - Article
C2 - 27379841
AN - SCOPUS:84977111953
SN - 1387-1307
VL - 31
SP - 793
EP - 796
JO - Journal of Clinical Monitoring and Computing
JF - Journal of Clinical Monitoring and Computing
IS - 4
ER -