背景:术中神经生理监测(IONM)用于关键结构的定位以及实时检测和预防术中神经损伤。在神经外科手术期间使用IONM监测舌下神经,耳鼻喉科,和血管手术,以改善手术结果。很少有文献描述舌下神经IONM的潜在并发症,尤其是在气道损害方面。在这里,我们介绍了有关舌下神经监测后急性气道阻塞病例的发现。
方法:一名54岁的男性因左侧远外侧开颅术和左侧小脑后下动脉(PICA)动脉瘤的显微手术夹闭而入院。在诱导和插管之后,但在程序开始之前,患者处于3/4俯卧位,左侧朝上,颈部弯曲约10度。然后,他将皮下针电极放入面部肌肉,斜方肌,软腭,和IONM的舌头。手术持续523分钟,无并发症发生。然而,全身麻醉出现后大约一小时,患者出现严重的舌部肿胀继发的进行性呼吸困难。他需要在纤维支气管镜的引导下紧急放置鼻气管导管。他保持插管3天,用地塞米松治疗,之后肿胀消退,患者成功拔管。
结论:急性舌水肿是一种可能危及生命的现象,可导致气道迅速受损。一般来说,急性舌肿胀的原因包括出血,水肿,梗塞,和感染。在上述情况下,我们怀疑舌供血管的创伤性损伤导致深部组织血肿,导致术后急性舌部肿胀和气道阻塞。随着IONM的广泛使用,医生必须意识到围手术期气道受损是一种潜在的危及生命的并发症,特别是关于舌下神经的监测。在这种情况下,可以成功地采用唤醒光纤鼻气管插管来建立紧急气道。
Intraoperative neurophysiological monitoring (IONM) is utilized for both the localization of critical structures and for real time detection and prevention of intraoperative neurological injury. Use of IONM to monitor the hypoglossal
nerve is performed during neurosurgical, otolaryngological, and vascular procedures to improve surgical outcomes. There is a paucity of literature describing potential complications of IONM of the hypoglossal
nerve, especially with respect to airway compromise. Here we present our findings regarding a
case of acute airway obstruction following hypoglossal
nerve monitoring.
A 54-year-old male was admitted for left far-lateral craniotomy and microsurgical clipping of a left posterior inferior cerebellar artery (PICA) aneurysm. Following induction and intubation but prior to the procedure start, the patient was placed in the ¾ prone position with the left side up and his neck was flexed approximately 10 degrees. He then underwent placement of subdermal needle electrodes into the facial muscles, trapezius muscles, soft palate, and tongue for IONM. The procedure lasted 523 minutes and was completed without complication. However, approximately one hour after emergence from general anesthesia, the patient experienced progressive difficulty breathing secondary to severe lingual swelling. He required emergent placement of a nasotracheal tube guided by a fiberoptic bronchoscope. He remained intubated for 3 days and was treated with dexamethasone, after which the swelling resolved, and the patient was successfully extubated.
Acute lingual edema is a potentially life-threatening phenomenon that can lead to rapid airway compromise. Generally, causes of acute lingual swelling include hemorrhage, edema, infarction, and infection. In the
case described above, we suspect traumatic injury to the tongue\'s vascular supply caused a deep tissue hematoma leading to postoperative acute lingual swelling and airway obstruction. With the widespread use of IONM, it becomes essential for providers to be aware that perioperative airway compromise is a potentially life-threatening complication, especially with respect to monitoring of the hypoglossal
nerve. Awake fiberoptic nasotracheal intubation can successfully be employed to establish an emergency airway in such situations.