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Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note
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Intraoperative Hypoglossal Nerve Mapping During Carotid Endarterectomy: Technical Note
Atsuhiro Kojima1, Isako Saga1, Mami Ishikawa2
1Department of Neurosurgery, Saitama City Hospital, Saitama, Japan.
World Neurosurgery
|March 5, 2018
Summary
Intraoperative hypoglossal nerve mapping accurately identifies the hypoglossal nerve during carotid endarterectomy (CEA). This technique prevents nerve injury and avoids the need for extensive tissue retraction, improving patient outcomes.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Nerve Monitoring
Background:
- Hypoglossal nerve palsy is a potential complication of carotid endarterectomy (CEA).
- Accidental injury to the hypoglossal nerve during CEA can lead to permanent palsy.
- This study evaluates intraoperative hypoglossal nerve mapping to aid nerve identification during CEA.
Observation:
- A hand-held probe and tongue motor evoked potentials (MEPs) were used to detect the hypoglossal nerve in five CEA patients.
- The hypoglossal nerve was successfully identified in all cases during internal carotid artery exposure.
- Mapping was particularly effective when the nerve was obscured by the posterior belly of the digastric muscle.
Findings:
- Tongue MEPs were consistently obtained, confirming nerve identification.
- The hypoglossal nerve was accurately located without retracting surrounding tissues.
- No patients experienced hypoglossal nerve palsy postoperatively.
Implications:
- Intraoperative hypoglossal nerve mapping is a valuable tool for CEA.
- This technique enhances surgical safety by preventing nerve injury.
- It allows for precise nerve localization, potentially reducing operative time and complications.
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