Phrenic Nerve Stimulator Placement via the Cervical Approach: Technique and Anatomic Considerations

2021 ◽  
Author(s):  
Varun Padmanaban ◽  
Russell Payne ◽  
Karen Corbani ◽  
Sheena Corl ◽  
Elias B Rizk
Keyword(s):  
Phrenic Nerve ◽  
Cervical Spinal Cord ◽  
Surgical Anatomy ◽  
Detailed Knowledge ◽  
Nerve Stimulator ◽  
Advantages And Disadvantages ◽  
Cord Injury ◽  
Ventilation Weaning ◽  
Cervical Approach ◽  
High Cervical

Abstract BACKGROUND Diaphragmatic pacing via phrenic nerve stimulation can help improve breathing and facilitate mechanical ventilation weaning in patients with respiratory failure secondary to brainstem injury, high cervical spinal cord injury, or congenital central hypoventilation. Devices can be placed utilizing several techniques; however, nuances regarding placement are not well published. OBJECTIVE To describe our experience with phrenic nerve stimulator placement via the cervical approach with a focus on surgical anatomy, variations, and technique. METHODS Placement of phrenic nerve stimulator via a cervical approach is described in detail. RESULTS Successful placement of phrenic nerve stimulator without complication. CONCLUSION The cervical approach for the placement of a phrenic nerve stimulator is a safe and effective option for patients. Detailed knowledge of anatomy and anatomic variations is required. Potential advantages and disadvantages are discussed.

scholarly journals Long-term evaluation of phrenic nerve pacing for respiratory failure due to high cervical spinal cord injury

Spinal Cord ◽  
2012 ◽  
Vol 50 (12) ◽  
pp. 895-898 ◽  
Author(s):  
F J Romero ◽  
C Gambarrutta ◽  
A Garcia-Forcada ◽  
M A Marín ◽  
E Diaz de la Lastra ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Respiratory Failure ◽  
Phrenic Nerve ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Cord Injury ◽  
Term Evaluation ◽  
High Cervical

scholarly journals The Comparation of Two Instruments for Rat Cervical 2 Hemisection Model

2021 ◽  
Author(s):  
LinLin Shen ◽  
Chen Song ◽  
Liang Zhang ◽  
Kai Wang
Keyword(s):  
Survival Rate ◽  
Cervical Spinal Cord ◽  
Post Injury ◽  
Advantages And Disadvantages ◽  
Surgical Methods ◽  
Cord Injury ◽  
Group A ◽  
Group B ◽  
High Cervical ◽  
Hematoxylin Eosin

Abstract The lateral C2 hemisection (HS) rat is the most studied reclinical model in the study of respiratory function after high cervical spinal cord injury. There are two main surgical methods in several studies— microscissors or microscalpel. This study is to evaluate the experimental results between those two methods. In this study, we performed rat lateral C2HS by microscissors (group A) or microscalpel (group B). We record cut frequency during hemisection as well as recovery of diaphragm electrophysiology by electromyogram (EMG) on the 14th day post injury. On the 14th day post injury, we record survival rate and evaluated the injury extent by hematoxylin-eosin (HE) stain. As a result, we found that group A had milder C2 injury extent than group B, higher survival rate on the 14th day post injury, and higher percent of peak root mean square (RMS) EMG post injury to that before injury. However, group A had larger cut frequency during hemisection. Weigh the advantages and disadvantages, microscissors seem had superiority over microscalpel.

Clinical Advances in Diaphragm Pacing

2011 ◽  
Vol 6 (5) ◽  
pp. 289-297 ◽  
Author(s):  
Christopher T. Ducko
Keyword(s):  
Phrenic Nerve ◽  
Cervical Spinal Cord ◽  
Long Term Results ◽  
Diaphragm Pacing ◽  
Cord Injury ◽  
Chronic Progressive Disease ◽  
Central Hypoventilation ◽  
Hypoventilation Syndrome ◽  
High Cervical

Diaphragmatic pacing is a valuable tool that can significantly benefit certain patients with respiratory insufficiency provided they have an intact phrenic nerve and a functional diaphragm. Careful patient selection is critical to successful long-term results. The main populations that derive benefit from pacing include those with congenital or acquired central hypoventilation syndrome and more commonly those with a high cervical spinal cord injury, where the phrenic nerves remain intact. The pacing electrode of most phrenic nerve pacemakers is implanted directly on the phrenic nerve. A newer device relies on intramuscular implantation of the electrode on the diaphragm at the phrenic nerve motor point. Most patients can be successfully weaned from mechanical ventilation for a substantial time each day, if not completely. This has significant impact on quality of life and implications for healthcare costs. The potential exists for application of this technology to patients with other types of respiratory failure as investigative experience emerges. These include the chronic progressive disease, amyotrophic lateral sclerosis, or temporary scenarios in difficult-to-wean intensive care unit patients. This enabling technology should hold a place in the thoracic surgeon's armamentarium.

scholarly journals Paced breathing and phrenic nerve responses evoked by epidural stimulation following complete high cervical spinal cord injury in rats

2018 ◽  
Vol 125 (3) ◽  
pp. 687-696 ◽  
Author(s):  
Tatiana Bezdudnaya ◽  
Michael A. Lane ◽  
Vitaliy Marchenko
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Phrenic Nerve ◽  
Cervical Spinal Cord ◽  
Frequency Dependent ◽  
Epidural Stimulation ◽  
Tracheal Pressure ◽  
Cord Injury ◽  
Phrenic Nucleus ◽  
High Cervical

Spinal cord injury (SCI) at the level of cervical segments often results in life-threatening respiratory complications and requires long-term mechanical ventilator assistance. Thus restoring diaphragm activity and regaining voluntary control of breathing are the primary clinical goals for patients with respiratory dysfunction following cervical SCI. Epidural stimulation (EDS) is a promising strategy that has been explored extensively for nonrespiratory functions and to a limited extent within the respiratory system. The goal of the present study is to assess the potential for EDS at the location of the phrenic nucleus (C3–C5) innervating the diaphragm: the main inspiratory muscle following complete C1 cervical transection. To avoid the suppressive effect of anesthesia, all experiments were performed in decerebrate, C1 cervical transection, unanesthetized, nonparalyzed ( n = 13) and paralyzed ( n = 7) animals. Our results show that C4 segment was the most responsive to EDS and required the lowest threshold of current intensity, affecting tracheal pressure and phrenic nerve responses. High-frequency (200–300 Hz) EDS applied over C4 segment (C4-EDS) was able to maintain breathing with normal end-tidal CO2 level and raise blood pressure. In addition, 100–300 Hz of C4-EDS showed time- and frequency-dependent changes (short-term facilitation) of evoked phrenic nerve responses that may serve as a target mechanism for pacing of phrenic motor circuits. The present work provides the first report of successful EDS at the level of phrenic nucleus in a complete SCI animal model and offers insight into the potential therapeutic application in patients with high cervical SCI. NEW & NOTEWORTHY The present work offers the first demonstration of successful life-supporting breathing paced by epidural stimulation (EDS) at the level of the phrenic nucleus, following a complete spinal cord injury in unanesthetized, decerebrate rats. Moreover, our experiments showed time- and frequency-dependent changes of evoked phrenic nerve activity during EDS that may serve as a target mechanism for pacing spinal phrenic motor networks.

scholarly journals 162 Clinical Correlates of High Cervical Fractional Anisotropy in Acute Cervical Spinal Cord Injury

Neurosurgery ◽  
2013 ◽  
Vol 60 ◽  
pp. 174 ◽  
Author(s):  
Aditya Vedantam ◽  
Gerald Eckardt ◽  
Marjorie C. Wang ◽  
Brian Schmit ◽  
Shekar N. Kurpad
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Fractional Anisotropy ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Clinical Correlates ◽  
Cord Injury ◽  
High Cervical

scholarly journals A Latent Propriospinal Network Can Restore Diaphragm Function after High Cervical Spinal Cord Injury

Cell Reports ◽  
2017 ◽  
Vol 21 (3) ◽  
pp. 654-665 ◽  
Author(s):  
Jared M. Cregg ◽  
Kevin A. Chu ◽  
Lydia E. Hager ◽  
Rachel S.J. Maggard ◽  
Daimen R. Stoltz ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Diaphragm Function ◽  
Cord Injury ◽  
High Cervical
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