Laryngeal manifestations of cranial nerve IX/X compression at the brainstem.

Autor: Taylor RJ; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A., Lowe SR; Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A., Ellis N; College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A., Abdullah E; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A., Patel S; Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A., Halstead LA; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2019 Sep; Vol. 129 (9), pp. 2105-2111. Date of Electronic Publication: 2018 Dec 24.
DOI: 10.1002/lary.27678
Abstrakt: Objective: We report an association between lower cranial nerve (CN IX/X) vascular compression at the brainstem with laryngeal symptoms utilizing a stepwise algorithm that systematically evaluates and eliminates all other common etiologies. Our experiences with retromastoid craniectomy with lower cranial nerve (LCN) decompression versus non-neurosurgical treatments are detailed.
Study Design: Retrospective chart review at a tertiary care academic medical center with follow-up telephone survey.
Methods: Baseline demographics, clinical characteristics, quality-of-life surveys, and treatment outcomes were recorded for patients with laryngeal symptoms associated with LCN compression at the brainstem.
Results: Forty-nine patients demonstrated LCN compression at the brainstem on imaging and presented with chief complaints of dysphonia (25 of 49, 51%), chronic cough (19 of 49, 39%), dysphoric breathing (3 of 49, 6%), and dysphagia (2 of 49, 4%). Poor initial scores were noted for Voice-Related Quality of Life (V-RQOL), Reflux Symptom Index, and Glottal Closure Index. Twenty-four patients underwent LCN decompression, of which 21 of 24 (88%) reported partial, near-complete, or complete improvement. Major perioperative complications occurred in four of 24 patients (17%). Patients who had undergone decompression were more likely to obtain complete/near-complete symptom resolution (10 of 24 patients, 42%) compared to those undergoing conservative treatments (2 of 25 patients, 8%) (P = 0.02). V-RQOL scores improved more in surgical patients [mean change score, 33.0 (standard deviation [SD], 31.2) than nonsurgical patients (mean change score 9.6, SD 20.9) (P = 0.03) (mean follow-up 3.0 years, SD 2.0).
Conclusion: Lower cranial nerve compression at the brainstem should be considered when all other etiologies are excluded. Retromastoid craniectomy with LCN decompression demonstrates an acceptable safety profile.
Level of Evidence: 4 Laryngoscope, 129:2105-2111, 2019.
(© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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