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Intraoperative neurophysiological monitoring in predicting dysphagia after brainstem and fourth ventricle surgeryстатья
- Авторы: Lapteva Kristina, Gavrjushin Andrey, Pitskhelauri David, Birg Tatiana, Danilov Gleb, Ogurtsova Anna, Strunina Yulia, Fomochkina Ludmila
- Журнал: World Neurosurgery
- Год издания: 2023
- Издательство: Elsevier BV
- Местоположение издательства: Netherlands
- Первая страница: 1
- Последняя страница: 7
- DOI: 10.1016/j.wneu.2023.09.069
- Аннотация: AbstractOBJECTIVEDysphagia represents the main complication of the posterior fossa neurosurgery. Adequate prognostication of this complication is warranted in order to prevent untimely extubation with subsequent aspiration. Intraoperative neurophysiological monitoring (IONM) modalities may be used for this purpose. However, it is currently unknown which IONM modality may be significant for prognostication. This study aimed at defining the most significant IONM modality for dysphagia prognostication following the posterior fossa neurosurgery.METHODSThe analysis included 46 patients: 34 with tumors of the fourth ventricle and 12 with brainstem localization, who underwent surgical excision of the tumor. Neurological symptoms before and after neurosurgery were noted and magnetic resonance imaging with the subsequent volume estimation of the removed mass was performed, followed by an IONM findings analysis (mapping of the nucleus of the caudal cranial nerves (CN) and corticobulbar motor-evoked potentials (CoMEP)).RESULTSAggravation of dysphagia was noted in 24% of the patients, more often in patients with tumor localization in the fourth ventricle (26%) than in those with brainstem mass lesions (16%). Mapping of the caudal cranial nerve nuclei did not correlate with the dysfunction of these structures. CoMEP was significantly associated with the neurological state of the CN. The decrease in CoMEP is a significant prognostic factor for postoperative bulbar symptoms appearance or aggravation.CONCLUSIONMapping the CN is an important identification tool. The CoMEP modality should be used intraoperatively to determine the functional state of the CN and predict postoperative dysphagia.
- Добавил в систему: Гаврюшин Андрей Владимирович