• Ryohei Chiba, Rei Enatsu, Satoko Ochi, Shoto Yamada, Ayaka Sasagawa, Hime Suzuki, Rintaro Yokoyama, Tsukasa Hirano, Masayasu Arihara, Tomoyoshi Kuribara, and Nobuhiro Mikuni.
• Department of Neurosurgery, Sapporo Medical University Hospital, Sapporo, Japan.
• World Neurosurg. 2019 Nov 1; 131: 191-193.

BackgroundVagus nerve stimulation is a palliative treatment for patients with refractory epilepsy; however, the misplacement of electrodes may cause complications and thus needs to be avoided.MethodsWe herein report an intraoperative monitoring technique to prevent the misplacement of electrodes. Endotracheal tube electrodes were inserted to record electromyographic activity from the vocal cords and identify the vagus nerve. Electromyography electrodes were placed on the sternomastoid muscle, sternohyoid muscle, geniohyoid muscle, and trapezius muscle to record muscle activities innervated by the ansa cervicalis. The vagus nerve and ansa cervicalis were electrically stimulated during surgery, and electromyography of the vocal cords and muscles innervated by the ansa cervicalis was recorded. The threshold of vagus nerve activation ranged between 0.05 and 0.75 mA.ResultsThe vagus nerve was successfully identified and differentiated from the nerve root of the ansa cervicalis using this technique.ConclusionsIntraoperative monitoring of the vagus nerve and ansa cervicalis is useful for safe and effective vagus nerve stimulation.Copyright © 2019 Elsevier Inc. All rights reserved.

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