Monitorización neurofisiológica intraoperatoria del nervio frénico: utilidad y descripción de la técnica / Intraoperative neurophysiological monitoring of the phrenic nerve: utility and descriptions of the technique

En procedimientos quirúrgicos de las regiones supraclaviculares y laterales cervicales, así como en cirugías cardíacas y mediastínicas, la función diafragmática puede comprometerse desde la base del riesgo de lesión del nervio frénico y/o la raíz C4. Son escasas las publicaciones que tratan la estimulación intraoperatoria de estas estructuras nerviosas para evaluar su funcionalidad y, en nuestro conocimiento, hasta ahora no se ha hipotetizado acerca de si es posible reducir las tasas de lesión situadas en hasta el 26% en algunos estudios de cirugía cardíaca. Describimos la técnica empleada para la monitorización neurofisiológica del nervio frénico. Asimismo, se discute su utilidad y ventajas respecto a otras técnicas. Concluimos que con la incorporación creciente de la monitorización neurofisiológica intraoperatoria en los últimos años, es posible su aplicación al nervio frénico en los procedimientos en los que se considere que existe riesgo de lesión del mismo y, con ella, puede ser factible la reducción de las tasas de lesión iatrógena

In surgical procedures of the supraclavicular and lateral cervical regions, as well as in cardiac and mediastinal surgeries, diaphragm function can be compromised by the risk of injury to the phrenic nerve and/or the C4 root. There are few publications that treat the intraoperative stimulation of these nerve structures to evaluate their functionality and, to our knowledge, until now it has not been hypothesized about whether it is possible to reduce the injury rates, which reach 26% in some cardiac surgery studies. We describe the technique used for the neurophysiological monitoring of the phrenic nerve. Also, its usefulness and advantages over other techniques are discussed. We conclude that, with the increasing incorporation in recent years of intraoperative neurophysiological monitoring, its application to the phrenic nerve is possible in procedures with a risk of injury and, thus, the reduction of iatrogenic injury rates may be feasible

Intraoperative neurophysiological monitoring of the phrenic nerve: utility and descriptions of the technique. / Monitorización neurofisiológica intraoperatoria del nervio frénico: utilidad y descripción de la técnica.

In surgical procedures of the supraclavicular and lateral cervical regions, as well as in cardiac and mediastinal surgeries, diaphragm function can be compromised by the risk of injury to the phrenic nerve and/or the C4 root. There are few publications that treat the intraoperative stimulation of these nerve structures to evaluate their functionality and, to our knowledge, until now it has not been hypothesized about whether it is possible to reduce the injury rates, which reach 26% in some cardiac surgery studies. We describe the technique used for the neurophysiological monitoring of the phrenic nerve. Also, its usefulness and advantages over other techniques are discussed. We conclude that, with the increasing incorporation in recent years of intraoperative neurophysiological monitoring, its application to the phrenic nerve is possible in procedures with a risk of injury and, thus, the reduction of iatrogenic injury rates may be feasible.

Neurilemoma del nervio vago cervical simulando adenoma de paratiroides / Cervical vagus nerve neurilemmoma mimicking parathyroid adenoma

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Hallazgo intraoperatorio, de nervio laríngeo inferior no recurrente, durante intervención por carcinoma papilar de tiroides / Intraoperative finding of non-recurrent inferior laryngeal nerve during papillary thyroid carcinoma surgery

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[Gallstones in a retained gastric antrum]. / Concreción litiásica en antro gástrico retenido.

Retained gastric antrum arises when there is incomplete excision of the gastric antrum during Billroth II gastrectomy for peptic ulcer disease. We report the case of a patient with gallstones in a retained gastric antrum, without biliodigestive fistula. This finding is extremely rare and we have found no previously reported cases in the literature.

Concreción litiásica en antro gástrico retenido / Gallstones in a retained gastric antrum

El antro gástrico retenido tiene lugar cuando se realiza una exéresis incompleta del antro gástrico durante una gastrectomía tipo Billroth II por enfermedad ulcerosa péptica. Se presenta el caso de un paciente con antro gástrico retenido con una concreción litiásica en su interior, sin fístula biliodigestiva, como un hallazgo extraordinariamente raro que no hemos encontrado descrito previamente en la literatura (AU)

Retained gastric antrum arises when there is incomplete excision of the gastric antrum during Billroth II gastrectomy for peptic ulcer disease. We report the case of a patient with gallstones in a retained gastric antrum, without biliodigestive fistula. This finding is extremely rare and we have found no previously reported cases in the literature (AU)