The terminal segment of the human phrenic nerve as a novel implantation site for diaphragm pacing electrodes: Anatomical and clinical description.
Ann Anat
; 239: 151835, 2022 Jan.
Article
em En
| MEDLINE
| ID: mdl-34562604
ABSTRACT
BACKGROUND:
Diaphragm pacing allows certain ventilator-dependent patients to achieve weaning from mechanical ventilation. The reference method consists in implanting intrathoracic contact electrodes around the phrenic nerve during video-assisted thoracic surgery, which involves time-consuming phrenic nerve dissection with a risk of nerve damage. Identifying a phrenic segment suitable for dissection-free implantation of electrodes would constitute progress. STUDYDESIGN:
This study characterizes a free terminal phrenic segment never fully described before. We conducted a cadaver study (n = 14) and a clinical observational study during thoracic procedures (n = 54).RESULTS:
A free terminal phrenic segment was observed on both sides in 100% of cases, "jumping" from the pericardium to the diaphragm and measuring 60 mm [95% confidence interval; 48-63] and 72.5 mm [65-82] (right left, respectively; p = 0.0038; cadaver study). This segment rolled up on itself at end-expiration and became unravelled and elongated with diaphragm descent (clinical study). Three categories of fat pads were defined (type 1 pericardiophrenic bundle free of surrounding fat; type 2 single fatty fringe leaving the phrenic nerve visible until diaphragmatic entry; type 3 multiple fatty fringes masking the site of penetration of the phrenic nerve) that depended on body mass index (p = 0.001, clinical study). Hematoxylin-eosin and toluidine blue staining (cadaver study) showed that all of the phrenic fibers in the distal, pre-branching part of the terminal segment were contained within a single epineurium containing a variable number of fascicles (right 1 [95%CI 0.65-4.01]; left 5 [3.37-7.63]; p = 0.03).CONCLUSION:
Diaphragm pacing through periphrenic electrodes positioned on the terminal phrenic segment should be tested.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Nervo Frênico
/
Diafragma
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Revista:
Ann Anat
Assunto da revista:
ANATOMIA
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
França