Intraoperative Neurophysiologic Testing of the Perigastric Vagus Nerve Branches to Evaluate Viability and Signals along Nerve Pathways during Gastrectomy

Kong, Seong-Ho,Kim, Sung Min,Kim, Dong-Gun,Park, Kee Hong,Suh, Yun-Suhk,Kim, Tae-Han,Kim, Il Jung,Seo, Jeong-Hwa,Lim, Young Jin,Lee, Hyuk-Joon,Yang, Han-Kwang The Korean Gastric Cancer Association 2019 Journal of gastric cancer Vol.19 No.1

Purpose: The perigastric vagus nerve may play an important role in preserving function after gastrectomy, and intraoperative neurophysiologic tests might represent a feasible method of evaluating the vagus nerve. The purpose of this study is to assess the feasibility of neurophysiologic evaluations of the function and viability of perigastric vagus nerve branches during gastrectomy. Materials and Methods: Thirteen patients (1 open total gastrectomy, 1 laparoscopic total gastrectomy, and 11 laparoscopic distal gastrectomy) were prospectively enrolled. The hepatic and celiac branches of the vagus nerve were exposed, and grabbing type stimulation electrodes were applied as follows: 10-30 mA intensity, 4 trains, $1,000{\mu}s/train$, and $5{\times}$frequency. Visible myocontractile movement and electrical signals were monitored via needle probes before and after gastrectomy. Gastrointestinal symptoms were evaluated preoperatively and postoperatively at 3 weeks and 3 months, respectively. Results: Responses were observed after stimulating the celiac branch in 10, 9, 10, and 6 patients in the antrum, pylorus, duodenum, and proximal jejunum, respectively. Ten patients responded to hepatic branch stimulation at the duodenum. After vagus-preserving distal gastrectomy, 2 patients lost responses to the celiac branch at the duodenum and jejunum (1 each), and 1 patient lost response to the hepatic branch at the duodenum. Significant procedure-related complications and meaningful postoperative diarrhea were not observed. Conclusions: Intraoperative neurophysiologic testing seems to be a feasible methodology for monitoring the perigastric vagus nerves. Innervation of the duodenum via the celiac branch and postoperative preservation of the function of the vagus nerves were confirmed in most patients.

Intraoperative Neurophysiologic Testing of the Perigastric Vagus Nerve Branches to Evaluate Viability and Signals along Nerve Pathways during Gastrectomy

공성호,김성민,김동건,박기홍,서윤석,김태한,Il Jung Kim,Jeonghwa Seo,Young Jin Lim,Hyuk-Joon Lee,Han-Kwang Yang 대한위암학회 2019 Journal of gastric cancer Vol.19 No.1

Purpose: The perigastric vagus nerve may play an important role in preserving function after gastrectomy, and intraoperative neurophysiologic tests might represent a feasible method of evaluating the vagus nerve. The purpose of this study is to assess the feasibility of neurophysiologic evaluations of the function and viability of perigastric vagus nerve branches during gastrectomy. Materials and Methods: Thirteen patients (1 open total gastrectomy, 1 laparoscopic total gastrectomy, and 11 laparoscopic distal gastrectomy) were prospectively enrolled. The hepatic and celiac branches of the vagus nerve were exposed, and grabbing type stimulation electrodes were applied as follows: 10–30 mA intensity, 4 trains, 1,000 μs/train, and 5× frequency. Visible myocontractile movement and electrical signals were monitored via needle probes before and after gastrectomy. Gastrointestinal symptoms were evaluated preoperatively and postoperatively at 3 weeks and 3 months, respectively. Results: Responses were observed after stimulating the celiac branch in 10, 9, 10, and 6 patients in the antrum, pylorus, duodenum, and proximal jejunum, respectively. Ten patients responded to hepatic branch stimulation at the duodenum. After vagus-preserving distal gastrectomy, 2 patients lost responses to the celiac branch at the duodenum and jejunum (1 each), and 1 patient lost response to the hepatic branch at the duodenum. Significant procedure-related complications and meaningful postoperative diarrhea were not observed. Conclusions: Intraoperative neurophysiologic testing seems to be a feasible methodology for monitoring the perigastric vagus nerves. Innervation of the duodenum via the celiac branch and postoperative preservation of the function of the vagus nerves were confirmed in most patients.

깊은호흡 시 미주신경 전기자극이 호흡근 활성과 호흡능력에 미치는 효과(사례 연구)

문현주,Moon, Hyunju 대한통합의학회 2019 대한통합의학회지 Vol.7 No.2

Purpose: The purpose of this study was to investigate the activity of respiratory muscle and lung capacity during deep breathing with electrical stimulation of the vagus nerve. Methods: This study was conducted on 30 healthy adults in their 20s. Subjects were randomly performed to deep breathing or deep breathing with vagus nerve electrical stimulation. All subjects' diaphragm and internal oblique muscle activity were measured during deep breathing by electromyography, and lung capacity was measured by spirometry immediately after beep breathing. In the vagus nerve stimulation method, the surface electrode was cut into the left ear and then electrically stimulated using a needle electric stimulator. Results: The activity of diaphragm was significantly increased in deep breathing with vagus nerve electrical stimulation than in deep breathing. However, lung capacity did not show any significant difference according to the condition. Conclusion: Vagus nerve electrical stimulation could induce diaphragm activity more than deep breathing alone. Deep breathing with vagus nerve electrical stimulation may enhance the activity of the respiratory muscles and is expected to be an effective treatment for the elderly or COPD patients with poor breathing ability.

미주신경 자극이 흰쥐 십이지장 세로토닌 면역반응세포에 미치는 영향

조병필 연세대학교 원주의과대학 1995 원주의대논문집 Vol.8 No.1

경부미주신경에 발생한 신경초종 - 증례 보고 -

이승면,최영근,전신수,박춘근,김문찬,강준기 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.2

흰쥐 중추신경계내 난소로 투사하는 미주신경로에 관한 연구

김명주,장명세,고미희,노해숙,조해영,오문유,이봉희 濟州大學校 基礎科學硏究所 2001 基礎科學硏究 Vol.14 No.1

본 실험은 부교감신경의 하나인 미주신경이 난소를 지배하는 신경으로 관여하고 있는지를 pseudorabies 바이러스를 이용하여 난소신경로와 난소주사후 미주신경절단을 통하여 조사한 연구 보고이다. 이를 위하여 Sprague Dawley계 암흰쥐를 대상으로 pseudorabies 바이러스를 난소에 주사한 무리와 난소 주사후 미주신경을 절단한 무리에서 뇌를 적출하여 pseudorabies 바이러스에 대한 면역조직화학 염색을 시행하여 비교하였다. 본 실험결과 미주신경 중추신경로내의 상위신경핵들이 pseudorabied 바이러스에 대하여 양성반응이 줄어들었거나 관찰되지 않는 차이를 보였다. 즉 적색핵, 종말판혈관기관, 줄무늬체, 침상핵과 이마엽겉질은 부분적으로 난소의 미주신경로에 관여하고 있으며 미주신경등쪽핵, 고립로핵, 최후영역, 청색반점, 팔옆핵, 코리케퓨즈핵, 흑색질 및 시각교차위핵은 양성반응이 관찰되지 않아 미주신경으로 투사하는 부교감신경핵으로 조사되었다. The mammalian ovary has been known as receiving its innervation by sympathetic and sensory neurons of the peripheral nervous system from the brain. Recently, there were several functional reports that the vagus nerves were also regulating the ovarian function, but the vagus nerve had not been identified by clear morphological evidence. A viral transneuronal tracing technique has been used to demonstrate the morphological evidence for the central vagal involvement in ovarian innervation in brain areas. Bartha strain of pseudorabies virus injection was made into the ovary of Sprague Dawley rats. In experimental group, the vagus nerve of the same injection side was removed right after ovarian injection. At five days after initial injection, all the rats were sacrificed and brains were processed for immunohistochemistry. Several central nuclei including hypothalamic paraventricular nucleus showed strong bilateral positive labelings after unilateral injection in control rats, but the positive labelings were disappeared or decreased in several hypothalamic nuclei and nuclei of the vagus nerve. I n conclusion, these results provide the morphological evidence that vagus nerve has neural connection to ovary and by which the central nervous system may maintains the state of ovulation and reproduction as a possible parasympathetic routes in mammals.

Vagal Paraganglioma: Surgical Removal with Superior Laryngeal Nerve Preservation

Thomas Kotsis,Panagitsa Christoforou 대한혈관외과학회 2019 Vascular Specialist International Vol.35 No.2

Vagal paragangliomas (VPGLs) represent <5% of all head and neck paragangliomas (PGLs) and show a 17% to 20% risk of malignancy. We present a rare case of a 50-year-old gender with a left VPGL in her neck. To date, approximately 200 cases have been reported. The tumor showed web-like adhesions and arterial supply from the external carotid artery. We performed en bloc resection including a part of the vagus nerve. The superior laryngeal nerve was preserved with the “human communicating nerve” which maintains neural communication in >70% of humans, providing motor fibers to the larynx. The patient recovered uneventfully and was discharged on the 3rd postoperative day. These tumors are therapeutically challenging owing to their proximity to vital neck and skull base structures. Early detection decreases surgical morbidity and mortality. Preservation of viable neural tissue is important in advanced disease.

Concomitant Injury of Vagus and Hypoglossal Nerves Caused by Fracture of Skull Base: A Case Report and Literature Review

이상훈,오재상,김도의,김윤태 대한신경손상학회 2020 Korean Journal of Neurotrauma Vol.16 No.2

Injury of lower cranial nerves (CNs) by skull base fracture afer head trauma can occursometimes. However, selectively different CN damage on either side is extremely rare. A 53-year-old man had difculty of swallowing, phonation, and articulation afer fallingoff his bicycle. In physical examination, a deviated tongue to the right side was shown. Brain computed tomography showed a skull base fracture involving bilateral jugularforamina and right hypoglossal canal. Lef vocal cord palsy was confrmed by laryngoscopy. Electromyography confrmed injury of lef superior laryngeal nerve, recurrent laryngealnerve, and right hypoglossal nerve. Video fluoroscopic swallowing study revealed largeamounts of remnant in vallecula and pyriform sinus without opening of upper esophagealsphincter due to dysfunction of cricopharyngeus muscle. Afer constant rehabilitation fordysphagia, he was allowed to eat a general diet with compensatory techniques at dischargeand further recovery afer 3 months. Injury of lower CNs afer fracture of the skull base cancause severe morbidity. However, the prognosis of such injuries can be favorable with earlyrehabilitation treatment by identifying the injured CN. A careful and accurate examination oflower CN injury in skull base fracture is essential for planning a treatment strategy

Hoarseness after Section of a Cervical Vagus Nerve Schwannoma

노성현,장호열 대한말초신경학회 2017 The Nerve Vol.3 No.1

Schwannomas of the cervical vagus nerve are slow-growing asymptomatic solitary neck masses that rarely undergo malignant change. We report the case of a 41-year-old man who presented with a six-month history of a painless neck mass and paroxysmal coughing after palpation of the mass. Surgical excision of the mass was performed, and histopathological examination revealed that the mass was a schwannoma. The patient developed hoarseness after removal of the schwannoma, which originated from the fibers of the recurrent laryngeal nerve (RLN). We describe the relationship of the tumor and RLN and review the anatomy of the vagus nerve.

고양이 복외측 연수 호흡신경세포의 활동에 미치는 말초 유해자극의 영향

김창진,김상정,구용숙,김전,최길수 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.3

Noxious peripheral nerve stimulation causes changes of arterial blood pressure by way of somatosympathetic reflex, and may play an important role in determining the periodicity of respiratory neurons at the same time. However, little has been known about how noxious stimulation does mediate respiratory control. In the present study, the respiratory neurons of the ventrolateral medulla were identified and characterized, and the responses of these neurons to noxious stimulation were observed, to investigate the role of noxious stimulation in determining respiratory rhythm. Cats were anesthetized with α-chloralose and mechanically ventilated after muscle relaxation. Occipital craniectomy was performed and the floor of the fourth ventricle was exposed. Single cell activities of the ventrolateral medulla were recorded using carbon-filament microelectrodes. Neurons related with respiratory rhythm were identified and the responses to vagal and sciatic nerve stimulation were observed. The following results were obtained. 1) A total of 46 neurons related with mechanical ventilatory cycle was identified, including 13 expiratory augmenting neurons, 11 inspiratory decrementing neurons, and 9 unclassified neurons. 2) The activity of inspiratory augmenting neurons was increased by A-δ intensity stimulation of the vagal and sciatic nerves, and inhibited by C-intensity stimulation of the sciatic nerve. 3) The inspiratory decrementing neurons did not show a significant response to vagal nerve stimulation, but the cell activity was inhibited by A-δ and C-intensity stimulation of the sciatic nerve. 4) The expiratory neuron did not show a significant response to peripheral nerve stimulation. 5) 27 neurons had slower rhythmic activity than mechanical ventilation. Sciatic nerve stimulation increased frequency of rhythmic discharges in these cells. 6) Most of the neurons with slower rhythmic activity during spontaneous respiration followed faster rhythm of mechanical ventilation after muscle relaxation. From these results, it is concluded that the activities of the respiratory neurons, especially inspiratory ones, in ventrolateral medulla are under influence of noxious peripheral stimulation, and they are dependent on the state of the experimental animal.