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Barham M, Streppel M, Guntinas-Lichius O, Fulgham-Scott N, Vogt J, Neiss WF. Treatment With Nimodipine or FK506 After Facial Nerve Repair Neither Improves Accuracy of Reinnervation Nor Recovery of Mimetic Function in Rats. Front Neurosci 2022; 16:895076. [PMID: 35645727 PMCID: PMC9136327 DOI: 10.3389/fnins.2022.895076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Nimodipine and FK506 (Tacrolimus) are drugs that have been reported to accelerate peripheral nerve regeneration. We therefore tested these substances aiming to improve the final functional outcome of motoric reinnervation after facial nerve injury. Methods In 18 female rats, the transected facial nerve was repaired by an artificial nerve conduit. The rats were then treated with either placebo, nimodipine, or FK506, for 56 days. Facial motoneurons were pre-operatively double-labeled by Fluoro-Gold and again 56 days post-operation by Fast-Blue to measure the cytological accuracy of reinnervation. The whisking motion of the vibrissae was analyzed to assess the quality of functional recovery. Results On the non-operated side, 93–97% of those facial nerve motoneurons innervating the vibrissae were double-labeled. On the operated side, double-labeling only amounted to 38% (placebo), 40% (nimodipine), and 39% (FK506), indicating severe misdirection of reinnervation. Regardless of post-operative drug or placebo therapy, the whisking frequency reached 83–100% of the normal value (6.0 Hz), but whisking amplitude was reduced to 33–48% while whisking velocity reached 39–66% of the normal values. Compared to placebo, statistically neither nimodipine nor FK506 improved accuracy of reinnervation and function recovery. Conclusion Despite previous, positive data on the speed and quantity of axonal regeneration, nimodipine and FK506 do not improve the final functional outcome of motoric reinnervation in rats.
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Affiliation(s)
- Mohammed Barham
- Department II of Anatomy, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
- *Correspondence: Mohammed Barham,
| | - Michael Streppel
- Department of Ear, Nose and Throat-Department (ENT), PAN-Clinic at Neumarkt, Cologne, Germany
| | | | - Nicole Fulgham-Scott
- Department I of Anatomy, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Johannes Vogt
- Department II of Anatomy, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Wolfram F. Neiss
- Department I of Anatomy, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
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2
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Mohammad R, Huh G, Cha W, Jeong WJ. Recurrent Laryngeal Nerve Paralysis Following Thyroidectomy: Analysis of Factors Affecting Nerve Recovery. Laryngoscope 2022; 132:1692-1696. [PMID: 35043983 DOI: 10.1002/lary.30024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 12/19/2021] [Accepted: 01/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Paralysis of the recurrent laryngeal nerves (RLNs), albeit decreased over the years, leaves the surgeon helpless as there is not much that can be done once it occurs. Nimodipine has been suggested as a remedy that could accelerate the recovery of the nerve. Our study aimed to examine the factors that affect the recovery rate (RR) and time to recovery (TTR) of post-thyroidectomy RLN paralysis, with an emphasis on the use of nimodipine. METHODS A total of 197 patients who had undergone thyroid and parathyroid surgeries were retrospectively reviewed from October 2016 to August 2019. Patients who had RLN paralysis following surgery were assessed. The medical records were retrospectively analyzed to look for possible factors that may influence RLN recovery. RESULTS A total of 289 nerves were at risk. Temporary RLN paralysis rate was 7.9% while 1.7% was permanent. Age (odds ratio [OR] = 4.8) and intra-operative extra-thyroid extension (OR = 9.0) were independent risk factors for RLN paralysis. The rate of recovery was 82.1%. Loss of signal (LOS; P = .066) was a factor trending for an impact on RR but not nimodipine (P > .05). The mean TTR was 32 days. LOS, nimodipine, and steroid use, among others, were factors trending for an impact on the TTR. CONCLUSION Although not reaching statistical significance, nimodipine and steroids might influence TTR but not the RR. Larger studies are warranted to address the effect of nimodipine on the outcome of RLN paralysis. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Ramla Mohammad
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Otolaryngology and Head and Neck Surgery, Jaber Al-Ahmad Hospital, Ministry of Health, South Surra, Kuwait
| | - Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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3
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Ali Akbari Ghavimi S, Gehret PM, Aronson MR, Schipani R, Smith KW, Borek RC, Germiller JA, Jacobs IN, Zur KB, Gottardi R. Drug delivery to the pediatric upper airway. Adv Drug Deliv Rev 2021; 174:168-189. [PMID: 33845038 DOI: 10.1016/j.addr.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
Pediatric upper airway disorders are frequently life-threatening and require precise assessment and intervention. Targeting these pathologies remains a challenge for clinicians due to the high complexity of pediatric upper airway anatomy and numerous potential etiologies; the most common treatments include systemic delivery of high dose steroids and antibiotics or complex and invasive surgeries. Furthermore, the majority of innovative airway management technologies are only designed and tested for adults, limiting their widespread implementation in the pediatric population. Here, we provide a comprehensive review of the most recent challenges of managing common pediatric upper airway disorders, describe the limitations of current clinical treatments, and elaborate on how to circumvent those limitations via local controlled drug delivery. Furthermore, we propose future advancements in the field of drug-eluting technologies to improve pediatric upper airway management outcomes.
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4
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Tibbetts KM, Simpson CB. Adult Bilateral Vocal Fold Paralysis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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5
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Nimodipine-Dependent Protection of Schwann Cells, Astrocytes and Neuronal Cells from Osmotic, Oxidative and Heat Stress Is Associated with the Activation of AKT and CREB. Int J Mol Sci 2019; 20:ijms20184578. [PMID: 31527507 PMCID: PMC6770698 DOI: 10.3390/ijms20184578] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/06/2019] [Accepted: 09/14/2019] [Indexed: 02/08/2023] Open
Abstract
Clinical and experimental data assumed a neuroprotective effect of the calcium channel blocker nimodipine. However, it has not been proven which neuronal or glial cell types are affected by nimodipine and which mechanisms underlie these neuroprotective effects. Therefore, the aim of this study was to investigate the influence of nimodipine treatment on the in vitro neurotoxicity of different cell types in various stress models and to identify the associated molecular mechanisms. Therefore, cell lines from Schwann cells, neuronal cells and astrocytes were pretreated for 24 h with nimodipine and incubated under stress conditions such as osmotic, oxidative and heat stress. The cytotoxicity was measured via the lactate dehydrogenase (LDH) activity of cell culture supernatant. As a result, the nimodipine treatment led to a statistically significantly reduced cytotoxicity in Schwann cells and neurons during osmotic (p ≤ 0.01), oxidative (p ≤ 0.001) and heat stress (p ≤ 0.05), when compared to the vehicle. The cytotoxicity of astrocytes was nimodipine-dependently reduced during osmotic (p ≤ 0.01), oxidative (p ≤ 0.001) and heat stress (not significant). Moreover, a decreased caspase activity as well as an increased proteinkinase B (AKT) and cyclic adenosine monophosphate response element-binding protein (CREB) phosphorylation could be observed after the nimodipine treatment under different stress conditions. These results demonstrate a cell type-independent neuroprotective effect of the prophylactic nimodipine treatment, which is associated with the prevention of stress-dependent apoptosis through the activation of CREB and AKT signaling pathways and the reduction of caspase 3 activity.
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6
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Christakis I, Klang P, Talat N, Galata G, Schulte KM. Long-term quality of voice is usually acceptable after initial hoarseness caused by a thyroidectomy or a parathyroidectomy. Gland Surg 2019; 8:226-236. [PMID: 31328101 DOI: 10.21037/gs.2018.09.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Vocal cord (VC) palsy following a thyroidectomy or parathyroidectomy can result in significant morbidity for the patient. We aimed to investigate the incidence of VC palsy in a tertiary referral Institution, track the management of these cases and record the long-term outcomes and VC recovery rates. Methods Retrospective review of all thyroidectomy/parathyroidectomy operations performed over 11 years. Patients with an unequivocal hoarse voice postoperatively were included. We analysed the patient's clinical characteristics and voice outcomes, operative, pathology and laryngoscopy reports during their follow-up. Results Ten patients fitted the inclusion criteria and were analysed. Median age at date of operation was 47.5 years (range, 16-81 years) and the M:F ratio was 1:2.3 (M:3, F:7). The median FU was 62.5 months (range, 12-144 months). The median hospital stay was 1.5 days (range, 1-87 days). There were 7 recurrent laryngeal nerve (RLN) injuries by manipulation, 1 case of RLN resection, 1 inadvertent division (with primary nerve repair) and 1 RLN was shaved off the thyroid. Long-term voice outcomes for the 7 patients with an RLN manipulation injury were: 3/7 patients had normal voice, 3/7 had moderate hoarseness and 1/7 had long-term hoarseness. The long-term voice outcome of the patient with RLN shaving off the thyroid gland was excellent while the 2 remaining patients (RLN resection and inadvertent division) needed 12 and 18 months respectively to achieve a normal quality of voice. Four out of the 10 patients had permanent VC palsy in the long-term and their voice outcomes varied: 1 patient had a normal voice, 2 patients had moderate hoarseness and 1 patient had persistent hoarseness. Only 1/10 patients did not show any voice improvement after 12 months. Conclusions In the vast majority of cases post-operative hoarseness due to RLN palsy improves in the long-term, albeit voice may not return completely to normal.
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Affiliation(s)
- Ioannis Christakis
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, Brixton, London, UK
| | - Patrick Klang
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, Brixton, London, UK
| | - Nadia Talat
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, Brixton, London, UK
| | - Gabriele Galata
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, Brixton, London, UK
| | - Klaus-Martin Schulte
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, Brixton, London, UK
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7
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Alizadeh-Mohajer M, Raisi A, Farjanikish G, Mohammadi R. Effect of Local Administration of Verapamil Combined with Chitosan Based Hybrid Nanofiber Conduit on Transected Sciatic Nerve in Rat. Bull Emerg Trauma 2019; 7:28-34. [PMID: 30719463 PMCID: PMC6360005 DOI: 10.29252/beat-070104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To assess the effect of locally administered verapamil on transected peripheral nerve regeneration and functional recovery. Methods: Sixty male healthy white Wistar rats were divided into four experimental groups (n=15), randomly: In transected group (TC), left sciatic nerve was transected and stumps were fixed in the adjacent muscle. In treatment group defect was bridged using chitosan tube (CHIT/Verapamil) filled with 10 µL verapamil (100ng/mL). In chitosan conduit group (CHIT), the tube was filled with phosphate-buffered saline alone. In sham-operated group (SHAM), sciatic nerve was exposed and manipulated. The repair trend was examined based on behavioral and performance tests as well as the variations of the gastrocnemius muscle, morphometric indices, and immunohistochemical indices. Results: Sciatic nerve functional study, muscle mass and morphometric indices confirmed faster recovery of regenerated axons in CHIT/Verapamil than CHIT group (P = 0.001). When loaded in a chitosan tube verapamil accelerated and improved functional recovery and morphometric indices of sciatic nerve. Immunohistochemical analysis revealed the S-100 protein was vastly present in the transverse nerve sections and the myelin sheath. In the treatment group (chit/verapamil), the immunohistochemical susceptibility of the axons being repaired and the axons in the myelin sheath to S-100 protein was higher than the other groups. Conclusion: The present study demonstrated that a single local application of verapamil could accelerate functional recovery after transection of sciatic nerve.
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Affiliation(s)
- Mahan Alizadeh-Mohajer
- Department of Clinical Sciences, Lorestan University, Khorramabad, Iran.,Resident of Veterinary Surgery Islamic Azad University, Science and Research Branch, Tehran
| | - Abbas Raisi
- Department of Clinical Sciences, Lorestan University, Khorramabad, Iran
| | | | - Rahim Mohammadi
- Department of Surgery and Diagnostic Imaging, Urmia University, Urmia, Iran
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8
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Lin RJ, Klein‐Fedyshin M, Rosen CA. Nimodipine improves vocal fold and facial motion recovery after injury: A systematic review and meta‐analysis. Laryngoscope 2018; 129:943-951. [DOI: 10.1002/lary.27530] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 11/12/2022]
Affiliation(s)
- R. Jun Lin
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Toronto, St. Michael's Hospital Toronto Ontario Canada
| | - Michele Klein‐Fedyshin
- Health Sciences Library System (HSLS), Research, Instruction, and Clinical Information Services DepartmentUniversity of Pittsburgh Pittsburgh Pennsylvania
| | - Clark A. Rosen
- UCSF Voice and Swallowing Center, Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco, San Francisco California U.S.A
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9
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Mattsson P, Frostell A, Björck G, Persson JKE, Hakim R, Zedenius J, Svensson M. Recovery of Voice After Reconstruction of the Recurrent Laryngeal Nerve and Adjuvant Nimodipine. World J Surg 2018; 42:632-638. [PMID: 29282507 PMCID: PMC5801379 DOI: 10.1007/s00268-017-4235-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Transection injury to the recurrent laryngeal nerve (RLN) has been associated with permanent vocal fold palsy, and treatment has been limited to voice therapy or local treatment of vocal folds. Microsurgical repair has been reported to induce a better function. The calcium channel antagonist nimodipine improves functional recovery after experimental nerve injury and also after cranial nerve injury in patients. This study aims to present voice outcome in patients who underwent repair of the RLN and received nimodipine during regeneration. Methods From 2002–2016, 19 patients were admitted to our center with complete unilateral injury to the RLN and underwent microsurgical repair of the RLN. After nerve repair, patients received nimodipine for 2–3 months. Laryngoscopy was performed repeatedly up to 14 months postoperatively. The Voice Handicap Index (VHI) was administered, and patients’ maximum phonation time (MPT) was recorded during the follow-up. Results All patients recovered well after surgery, and nimodipine was well tolerated with no dropouts. None of the patients suffered from atrophy of the vocal fold, and some patients even showed a small ab/adduction of the vocal fold on the repaired side with laryngoscopy. During long-term follow-up (>3 years), VHI and MPT normalized, indicating a nearly complete recovery from unilateral RLN injury. Conclusions In this cohort study, we report the results of the first 19 consecutive cases at our center subjected to reconstruction of the RLN and adjuvant nimodipine treatment. The outcome of the current strategy is encouraging and should be considered after iatrogenic RLN transection injuries.
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Affiliation(s)
- P Mattsson
- Division of Clinical CNS Research, Section of Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet R2:02, Karolinska University Hospital, 171 76, Stockholm, Sweden. .,Department of Breast, Endocrine and Sarcoma Tumors, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - A Frostell
- Division of Clinical CNS Research, Section of Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet R2:02, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - G Björck
- Department of ENT Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - J K E Persson
- Division of Clinical CNS Research, Section of Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet R2:02, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - R Hakim
- Division of Clinical CNS Research, Section of Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet R2:02, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - J Zedenius
- Department of Breast, Endocrine and Sarcoma Tumors, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - M Svensson
- Division of Clinical CNS Research, Section of Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet R2:02, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, 171 76, Stockholm, Sweden
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10
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Abstract
BACKGROUND Except for glucocorticoids there is a lack of neuroprotective medication in neurosurgical interventions. OBJECTIVE An overview of clinical trials investigating administration of the calcium antagonist nimodipine and hydroxyethyl starch (HES) in vestibular schwannoma (VS) surgery is given. Basic research is addressed and potential neuroprotective effect mechanisms are discussed, as are perspectives for application of the concept to other types of surgery with a risk postoperative impairment of nerve function. MATERIALS AND METHODS A selective PubMed search was performed and all 10 clinical trials corresponding to the search criteria were included. RESULTS Four trials with an intraoperative start of the medication showed a positive effect for the preservation of facial nerve function and hearing preservation. A pilot study showed superiority of prophylactic treatment over intraoperative application. There were no significant results in a prospective multicenter phase III trial. After 1 year, postoperative facial nerve preservation rates were excellent in both groups. However, the risk of hearing loss was twice as high in the control group. A combined analysis of the phase III trial with its pilot study showed significant results for better hearing preservation rates in the treatment group (probably by increasing the case load). CONCLUSION Prophylactic nimodipine can be recommended in VS surgery in patients with good preoperative hearing. The effect mechanisms of nimodipine and modifications to prophylaxis should be clarified in basic research.
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Affiliation(s)
- C Scheller
- Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinikum, Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - E Herzfeld
- Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinikum, Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - C Strauss
- Universitätsklinik und Poliklinik für Neurochirurgie, Universitätsklinikum, Universität Halle-Wittenberg, Halle (Saale), Deutschland
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11
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Nimodipine but Not Nifedipine Promotes Expression of Fatty Acid 2-Hydroxylase in a Surgical Stress Model Based on Neuro2a Cells. Int J Mol Sci 2017; 18:ijms18050964. [PMID: 28467360 PMCID: PMC5454877 DOI: 10.3390/ijms18050964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 04/20/2017] [Accepted: 04/26/2017] [Indexed: 11/18/2022] Open
Abstract
Nimodipine is well characterized for the management of aneurysmal subarachnoid hemorrhage and has been shown to promote a better outcome and less delayed ischemic neurological deficits. Animal and clinical trials show neuroprotective efficacy following nerve injuries. We showed a neuroprotective effect on Neuro2a cells. Subsequent microarray analysis revealed—among others—fatty acid 2-hydroxylase (FA2H) upregulated by nimodipine in vitro, which is a component of myelin synthesis. Differentiated Neuro2a cells were analyzed for nimodipine-mediated survival considering stress treatment in comparison to nifedipine-treatment. Cell survival was determined by measurement of LDH activity in the culture medium. Nimodipine decreased surgery-like stress-induced cell death of differentiated Neuro2a cells. Neuro2a cell culture was analyzed for changes in FA2H expression induced by nimodipine or nifedipine in surgery-like stress conditions. We analyzed expression levels of FA2H mRNA and protein by qPCR using fa2h specific primers or a FA2H-specific antibody in nimodipine or nifedipine non- and pre-treated Neuro2a cell culture, respectively. Nimodipine but not nifedipine increases FA2H protein levels and also significantly increases mRNA levels of FA2H in both undifferentiated and differentiated Neuro2a cells. Our findings indicate that higher expression of FA2H induced by nimodipine may cause higher survival of Neuro2a cells stressed with surgery-like stressors.
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12
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Scheller C, Wienke A, Tatagiba M, Gharabaghi A, Ramina KF, Ganslandt O, Bischoff B, Zenk J, Engelhorn T, Matthies C, Westermaier T, Antoniadis G, Pedro MT, Rohde V, von Eckardstein K, Kretschmer T, Kornhuber M, Steighardt J, Richter M, Barker FG, Strauss C. Prophylactic nimodipine treatment and improvement in hearing outcome after vestibular schwannoma surgery: a combined analysis of a randomized, multicenter, Phase III trial and its pilot study. J Neurosurg 2017; 127:1376-1383. [PMID: 28298021 DOI: 10.3171/2016.8.jns16626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE In clinical routines, neuroprotective strategies in neurosurgical interventions are still missing. A pilot study (n = 30) and an analogously performed Phase III trial (n = 112) pointed to a beneficial effect of prophylactic nimodipine and hydroxyethyl starch (HES) in vestibular schwannoma (VS) surgery. Considering the small sample size, the data from both studies were pooled. METHODS The patients in both investigator-initiated studies were assigned to 2 groups. The treatment group (n = 70) received parenteral nimodipine (1-2 mg/hour) and HES (hematocrit 30%-35%) from the day before surgery until the 7th postoperative day. The control group (n = 72) was not treated prophylactically. Facial and cochlear nerve functions were documented preoperatively, during the inpatient care, and 1 year after surgery. RESULTS Pooled raw data were analyzed retrospectively. Intent-to-treat analysis revealed a significantly lower risk for hearing loss (Class D) 12 months after surgery in the treatment group compared with the control group (OR 0.46, 95% CI 0.22-0.97; p = 0.04). After exclusion of patients with preoperative Class D hearing, this effect was more pronounced (OR 0.38, 95% CI 0.17-0.83; p = 0.016). Logistic regression analysis adjusted for tumor size showed a 4 times lower risk for hearing loss in the treatment group compared with the control group (OR 0.25, 95% CI 0.09-0.63; p = 0.003). Facial nerve function was not significantly improved with treatment. Apart from dose-dependent hypotension (p < 0.001), the study medication was well tolerated. CONCLUSIONS Prophylactic nimodipine is safe and may be recommended in VS surgery to preserve hearing. Prophylactic neuroprotective treatment in surgeries in which nerves are at risk seems to be a novel and promising concept. Clinical trial registration no.: DRKS 00000328 ( https://drks-neu.uniklinik-freiburg.de/drks_web/ ).
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Affiliation(s)
- Christian Scheller
- Departments of 1 Neurosurgery and.,Translational Centre for Regenerative Medicine, University of Leipzig
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, and
| | | | | | | | | | | | | | | | - Cordula Matthies
- Department of Neurosurgery, Würzburg University Hospital, Würzburg
| | | | - Gregor Antoniadis
- Department of Neurosurgery, Bezirkskrankenhaus Günzburg, University of Ulm, Günzburg
| | - Maria Teresa Pedro
- Department of Neurosurgery, Bezirkskrankenhaus Günzburg, University of Ulm, Günzburg
| | - Veit Rohde
- Department of Neurosurgery, University of Göttingen; and
| | | | - Thomas Kretschmer
- Department of Neurosurgery, Evangelisches Krankenhaus, University of Oldenburg, Germany ; and
| | | | - Jörg Steighardt
- Coordination Centre for Clinical Trials, University of Halle-Wittenberg, Halle (Saale)
| | - Michael Richter
- Coordination Centre for Clinical Trials, University of Halle-Wittenberg, Halle (Saale)
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
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13
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Samlan RA, Story BH. Influence of Left-Right Asymmetries on Voice Quality in Simulated Paramedian Vocal Fold Paralysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:306-321. [PMID: 28199505 DOI: 10.1044/2016_jslhr-s-16-0076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/31/2016] [Indexed: 05/25/2023]
Abstract
PURPOSE The purpose of this study was to determine the vocal fold structural and vibratory symmetries that are important to vocal function and voice quality in a simulated paramedian vocal fold paralysis. METHOD A computational kinematic speech production model was used to simulate an exemplar "voice" on the basis of asymmetric settings of parameters controlling glottal configuration. These parameters were then altered individually to determine their effect on maximum flow declination rate, spectral slope, cepstral peak prominence, harmonics-to-noise ratio, and perceived voice quality. RESULTS Asymmetry of each of the 5 vocal fold parameters influenced vocal function and voice quality; measured change was greatest for adduction and bulging. Increasing the symmetry of all parameters improved voice, and the best voice occurred with overcorrection of adduction, followed by bulging, nodal point ratio, starting phase, and amplitude of vibration. CONCLUSIONS Although vocal process adduction and edge bulging asymmetries are most influential in voice quality for simulated vocal fold motion impairment, amplitude of vibration and starting phase asymmetries are also perceptually important. These findings are consistent with the current surgical approach to vocal fold motion impairment, where goals include medializing the vocal process and straightening concave edges. The results also explain many of the residual postoperative voice limitations.
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Affiliation(s)
- Robin A Samlan
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson
| | - Brad H Story
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson
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14
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Schneider R, Randolph G, Dionigi G, Barczyński M, Chiang FY, Triponez F, Vamvakidis K, Brauckhoff K, Musholt TJ, Almquist M, Innaro N, Jimenez-Garcia A, Kraimps JL, Miyauchi A, Wojtczak B, Donatini G, Lombardi D, Müller U, Pezzullo L, Ratia T, Van Slycke S, Nguyen Thanh P, Lorenz K, Sekulla C, Machens A, Dralle H. Prospective study of vocal fold function after loss of the neuromonitoring signal in thyroid surgery: The International Neural Monitoring Study Group's POLT study. Laryngoscope 2015; 126:1260-6. [PMID: 26667156 DOI: 10.1002/lary.25807] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Intraoperative neuromonitoring identifies recurrent laryngeal nerve (RLN) injury and gives prognostic information regarding postoperative glottic function. Loss of the neuromonitoring signal (LOS) signifies segmental type 1 or global type 2 RLN injury. This study aimed at identifying risk factors for RLN injury and determining vocal fold (VF) function initially and 6 months after definitive LOS. STUDY DESIGN Prospective study encompassing 21 hospitals from 13 countries. METHODS Included in this study were patients with persistent intraoperative LOS. RESULTS At first postoperative laryngoscopy, early VF palsy was present in 94 of all 115 patients with LOS (81.7%): in 53 of 56 patients (94.6%) with type 1 injury and 41 of 59 patients (69.5%) with type 2 injury. In LOS type 1, women outnumbered men >5-fold. Traction produced LOS type 1 in 38 of 56 patients (67.9%) and LOS type 2 in 54 of 59 patients (91.5%). Course of the RLN posterior and/or anterior to the inferior thyroid artery, extralaryngeal branching, or tuberculum of Zuckerkandl did not increase VF palsy rates. Permanent VF palsy rates were also lower (P = .661) after LOS type 2 than after LOS type 1: 6.8% (four of 59 patients) versus 10.7% (six of 56 patients). Intraoperative administration of steroids did not diminish postoperative VF palsy rates. CONCLUSIONS LOS type 1 entails more severe nerve damage than LOS type 2, affecting women disproportionately. Both LOS types, being primarily associated with traction injury, are unaffected by variant neck anatomy in expert hands and unresponsive to steroids. LEVEL OF EVIDENCE 2b Laryngoscope, 126:1260-1266, 2016.
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Affiliation(s)
- Rick Schneider
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
| | - Gregory Randolph
- Division of Thyroid and Parathyroid Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | | | - Marcin Barczyński
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University, Krakow, Poland
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Frédéric Triponez
- Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Katrin Brauckhoff
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - Thomas J Musholt
- Endocrine Surgery Section, Clinic of General, Visceral, and Transplantation Surgery, University Medical Center, Mainz, Germany
| | - Martin Almquist
- Department of Surgery, Lund University Hospital, Lund, Sweden
| | - Nadia Innaro
- Department of General Surgery, University of Catanzaro, Catanzaro, Italy
| | | | - Jean-Louis Kraimps
- Department of Endocrine Surgery, University Hospital of Poitiers, Poitiers, France
| | | | - Beata Wojtczak
- Department of General, Gastroenterological and Endocrine Surgery, Medical University Wrocław, Wrocław, Poland
| | - Gianluca Donatini
- Department of Endocrine Surgery, University Hospital of Poitiers, Poitiers, France
| | - Davide Lombardi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Uwe Müller
- Department of General, Viszeral and Thoracic Surgery, Bundeswehr Hospital, Berlin, Germany
| | - Luciano Pezzullo
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale, Naples, Italy
| | - Tomas Ratia
- Department of General Surgery, "Principe de Asturias" University Hospital, Madrid, Spain
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium
| | - Phuong Nguyen Thanh
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
| | - Kerstin Lorenz
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
| | - Carsten Sekulla
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
| | - Andreas Machens
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
| | - Henning Dralle
- Department of General, Visceral, and Vascular Surgery, University Hospital of Martin Luther University, Halle (Saale), Germany
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Scheller C, Wienke A, Tatagiba M, Gharabaghi A, Ramina KF, Ganslandt O, Bischoff B, Zenk J, Engelhorn T, Matthies C, Westermaier T, Antoniadis G, Pedro MT, Rohde V, von Eckardstein K, Kretschmer T, Kornhuber M, Steighardt J, Richter M, Barker FG, Strauss C. Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial. J Neurosurg 2015; 124:657-64. [PMID: 26274985 DOI: 10.3171/2015.1.jns142001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A pilot study of prophylactic nimodipine and hydroxyethyl starch treatment showed a beneficial effect on facial and cochlear nerve preservation following vestibular schwannoma (VS) surgery. A prospective Phase III trial was undertaken to confirm these results. METHODS An open-label, 2-arm, randomized parallel group and multicenter Phase III trial with blinded expert review was performed and included 112 patients who underwent VS surgery between January 2010 and February 2013 at 7 departments of neurosurgery to investigate the efficacy and safety of the prophylaxis. The surgery was performed after the patients were randomly assigned to one of 2 groups using online randomization. The treatment group (n = 56) received parenteral nimodipine (1-2 mg/hr) and hydroxyethyl starch (hematocrit 30%-35%) from the day before surgery until the 7th postoperative day. The control group (n = 56) was not treated prophylactically. RESULTS Intent-to-treat analysis showed no statistically significant effects of the treatment on either preservation of facial nerve function (35 [67.3%] of 52 [treatment group] compared with 34 [72.3%] of 47 [control group]) (p = 0.745) or hearing preservation (11 [23.4%] of 47 [treatment group] compared with 15 [31.2%] of 48 [control group]) (p = 0.530) 12 months after surgery. Since tumor sizes were significantly larger in the treatment group than in the control group, logistic regression analysis was required. The risk for deterioration of facial nerve function was adjusted nearly the same in both groups (OR 1.07 [95% CI 0.34-3.43], p = 0.91). In contrast, the risk for postoperative hearing loss was adjusted 2 times lower in the treatment group compared with the control group (OR 0.49 [95% CI 0.18-1.30], p = 0.15). Apart from dose-dependent hypotension (p < 0.001), no clinically relevant adverse reactions were observed. CONCLUSIONS There were no statistically significant effects of the treatment. Despite the width of the confidence intervals, the odds ratios may suggest but do not prove a clinically relevant effect of the safe study medication on the preservation of cochlear nerve function after VS surgery. Further study is needed before prophylactic nimodipine can be recommended in VS surgery.
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Affiliation(s)
- Christian Scheller
- Departments of 1 Neurosurgery and.,Translational Centre for Regenerative Medicine, University of Leipzig
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics; and
| | | | | | | | | | | | | | | | - Cordula Matthies
- Department of Neurosurgery, Würzburg University Hospital, Würzburg
| | | | - Gregor Antoniadis
- Department of Neurosurgery, Bezirkskrankenhaus Günzburg, University of Ulm
| | - Maria Teresa Pedro
- Department of Neurosurgery, Bezirkskrankenhaus Günzburg, University of Ulm
| | - Veit Rohde
- Department of Neurosurgery, University of Göttingen
| | | | - Thomas Kretschmer
- Department of Neurosurgery, Evangelisches Krankenhaus, University of Oldenburg, Germany; and
| | | | - Jörg Steighardt
- Coordination Centre for Clinical Trials, University of Halle-Wittenberg, Halle (Saale)
| | - Michael Richter
- Coordination Centre for Clinical Trials, University of Halle-Wittenberg, Halle (Saale)
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
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16
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Tang YD, Zheng XS, Ying TT, Yuan Y, Li ST. Nimodipine-mediated re-myelination after facial nerve crush injury in rats. J Clin Neurosci 2015; 22:1661-8. [PMID: 26169537 DOI: 10.1016/j.jocn.2015.03.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 12/19/2022]
Abstract
This study aimed to investigate the mechanism of nimodipine-mediated neural repair after facial nerve crush injury in rats. Adult Sprague-Dawley rats were divided into three groups: healthy controls, surgery alone, and surgery plus nimodipine. A facial nerve crush injury model was constructed. Immediately after surgery, the rats in the surgery plus nimodipine group were administered nimodipine, 6 mg/kg/day, for a variable numbers of days. The animals underwent electromyography (EMG) before surgery and at 3, 10, or 20 days after surgery. After sacrifice, nerve samples were stained with hematoxylin and eosin (H&E) and luxol fast blue. The EMG at 20 days revealed an apparent recovery of eletroconductivity, with the surgery plus nimodipine group having a higher amplitude and shorter latency time than the surgery only group. H&E staining showed that at 20 days, the rats treated with nimodipine had an obvious recovery of myelination and reduction in the number of infiltrating cells, suggesting less inflammation, compared with the rats in the surgery only group. Luxol fast blue staining was relatively even in the surgery plus nimodipine group, indicating a protective effect against injury-induced demyelination. Staining for S100 calcium-binding protein B (S-100β) was not evident in the surgery alone group, but was evident in the surgery plus nimodipine group, indicating that nimodipine reversed the damage of the crush injury. After a facial nerve crush injury, treatment with nimodipine for 20 days reduced the nerve injury by mediating remyelination by Schwann cells. The protective effect of nimodipine may include a reduction of inflammation and an increase in calcium-binding S-100β protein.
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Affiliation(s)
- Yin-da Tang
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Floor 16, Building 8, 1665 Kongjiang Road, Shanghai 200092, China
| | - Xue-sheng Zheng
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Floor 16, Building 8, 1665 Kongjiang Road, Shanghai 200092, China
| | - Ting-ting Ying
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Floor 16, Building 8, 1665 Kongjiang Road, Shanghai 200092, China
| | - Yan Yuan
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Floor 16, Building 8, 1665 Kongjiang Road, Shanghai 200092, China
| | - Shi-ting Li
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Floor 16, Building 8, 1665 Kongjiang Road, Shanghai 200092, China.
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Lekue A, García-López I, Santiago S, Del Palacio A, Gavilán J. Diagnosis and management with botulinum toxin in 11 cases of laryngeal synkinesis. Eur Arch Otorhinolaryngol 2015; 272:2397-402. [PMID: 25911949 DOI: 10.1007/s00405-015-3633-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/10/2015] [Indexed: 11/28/2022]
Abstract
Laryngeal synkinesis is a vocal fold movement disorder produced by a misdirected reinnervation after a recurrent laryngeal nerve injury. Its symptoms differ greatly between patients, requiring diverse therapeutical approaches. We aim to describe our experience in the diagnosis and treatment of different laryngeal synkinesis presentations. 11 patients diagnosed between 2011 and 2014 in a tertiary referral center with laryngeal synkinesis confirmed by laryngeal electromyography were included in our study. All medical records and laryngoscopic and electromyographic data were reviewed retrospectively. Four patients had previous unilateral vocal fold palsy and seven had a bilateral palsy with different degrees of clinical involvement. All of them showed paradoxical movements during inhalation in videofibrolaryngoscopic examination. Laryngeal electromyography confirmed the diagnosis of laryngeal synkinesis. Dyspnea was the main presentation symptom. Three patients with mild symptoms were not treated. Patients with unilateral vocal fold immobility were successfully treated with periodic botulinum toxin injections. Patients with bilateral immobility had a good initial response to botulinum toxin, although in some of them, a posterior cordectomy had to be finally performed. In conclusion, laryngeal synkinesis is a heterogeneous clinic entity that appears in patients with unilateral or bilateral vocal fold paralysis. Videofibrolaryngoscopy and laryngeal electromyography are essential to a correct diagnosis. Botulinum toxin injections are the main treatment for symptomatic cases, even if in bilateral palsy cases more aggressive treatments are often required.
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Affiliation(s)
- Asier Lekue
- Department of Otolaryngology, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain,
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18
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Mattsson P, Hydman J, Svensson M. Recovery of laryngeal function after intraoperative injury to the recurrent laryngeal nerve. Gland Surg 2015; 4:27-35. [PMID: 25713777 PMCID: PMC4321052 DOI: 10.3978/j.issn.2227-684x.2015.01.10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/26/2015] [Indexed: 11/14/2022]
Abstract
Loss of function in the recurrent laryngeal nerve (RLN) during thyroid/parathyroid surgery, despite a macroscopically intact nerve, is a challenge which highlights the sensitivity and complexity of laryngeal innervation. Furthermore, the uncertain prognosis stresses a lack of capability to diagnose the reason behind the impaired function. There is a great deal of literature considering risk factors, surgical technique and mechanisms outside the nerve affecting the incidence of RLN paresis during surgery. To be able to prognosticate recovery in cases of laryngeal dysfunction and voice changes after thyroid surgery, the surgeon would first need to define the presence, location, and type of laryngeal nerve injury. There is little data describing the events within the nerve and the neurobiological reasons for the impaired function related to potential recovery and prognosis. In addition, very little data has been presented in order to clarify any differences between the transient and permanent injury of the RLN. This review aims, from an anatomical and neurobiological perspective, to provide an update on the current understandings of surgically-induced injury to the laryngeal nerves.
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Affiliation(s)
- Per Mattsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Hydman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Svensson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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19
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Bork K, Wurm F, Haller H, Strauss C, Scheller C, Gnanapragassam VS, Horstkorte R. Neuroprotective and neuroregenerative effects of nimodipine in a model system of neuronal differentiation and neurite outgrowth. Molecules 2015; 20:1003-13. [PMID: 25584831 PMCID: PMC6272420 DOI: 10.3390/molecules20011003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/30/2014] [Indexed: 12/24/2022] Open
Abstract
Nimodipine is a Ca2+-channel antagonist mainly used for the management of aneurysmal subarachnoid hemorrhage (aSAH) to prevent cerebral vasospasms. However, it is not clear if the better outcome of nimodipine-treated patients is mainly due to vasodilatation or whether other cellular neuroprotective or neuregenerative effects of nimodipine are involved. We analysed PC12 cells after different stress stimuli with or without nimodipine pretreatment. Cytotoxicity of 200 mM EtOH and osmotic stress (450 mosmol/L) was significantly reduced with nimodipine pretreatment, while nimodipine has no influence on the hypoxia-induced cytotoxicity in PC12 cells. The presence of nimodipine also increased the NGF-induced neurite outgrowth in PC12 cells. However, nimodipine alone was not able to induce neurite outgrowth in PC12 cells. These results support the idea that nimodipine has general neuroprotective or neuregenerative effect beside its role in vasodilatation and is maybe useful also in other clinical applications beside aSAH.
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Affiliation(s)
- Kaya Bork
- Institute for Physiological Chemistry, Martin-Luther University, Hollystr. 1, Halle (Saale) D-06114, Germany.
| | - Franziska Wurm
- Institute for Physiological Chemistry, Martin-Luther University, Hollystr. 1, Halle (Saale) D-06114, Germany.
| | - Hannes Haller
- Institute for Physiological Chemistry, Martin-Luther University, Hollystr. 1, Halle (Saale) D-06114, Germany.
| | - Christian Strauss
- Department of Neurosurgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, Halle (Saale) D-06120, Germany.
| | - Christian Scheller
- Department of Neurosurgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, Halle (Saale) D-06120, Germany.
| | - Vinayaga S Gnanapragassam
- Institute for Physiological Chemistry, Martin-Luther University, Hollystr. 1, Halle (Saale) D-06114, Germany.
| | - Rüdiger Horstkorte
- Institute for Physiological Chemistry, Martin-Luther University, Hollystr. 1, Halle (Saale) D-06114, Germany.
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20
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Herzfeld E, Strauss C, Simmermacher S, Bork K, Horstkorte R, Dehghani F, Scheller C. Investigation of the neuroprotective impact of nimodipine on Neuro2a cells by means of a surgery-like stress model. Int J Mol Sci 2014; 15:18453-65. [PMID: 25318050 PMCID: PMC4227225 DOI: 10.3390/ijms151018453] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/09/2014] [Accepted: 09/23/2014] [Indexed: 12/14/2022] Open
Abstract
Nimodipine is well characterized for the management of SAH (subarachnoid hemorrhage) and has been shown to promote a better outcome and less DIND (delayed ischemic neurological deficits). In rat experiments, enhanced axonal sprouting and higher survival of motoneurons was demonstrated after cutting or crushing the facial nerve by nimodipine. These results were confirmed in clinical trials following vestibular Schwannoma surgery. The mechanism of the protective competence of nimodipine is unknown. Therefore, in this study, we established an in vitro model to examine the survival of Neuro2a cells after different stress stimuli occurring during surgery with or without nimodipine. Nimodipine significantly decreased ethanol-induced cell death of cells up to approximately 9% in all tested concentrations. Heat-induced cell death was diminished by approximately 2.5% by nimodipine. Cell death induced by mechanical treatment was reduced up to 15% by nimodipine. Our findings indicate that nimodipine rescues Neuro2a cells faintly, but significantly, from ethanol-, heat- and mechanically-induced cell death to different extents in a dosage-dependent manner. This model seems suitable for further investigation of the molecular mechanisms involved in the neuroprotective signal pathways influenced by nimodipine.
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Affiliation(s)
- Eva Herzfeld
- Department of Neurosurgery, Martin-Luther University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
| | - Christian Strauss
- Department of Neurosurgery, Martin-Luther University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
| | - Sebastian Simmermacher
- Department of Neurosurgery, Martin-Luther University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
| | - Kaya Bork
- Institute for Physiological Chemistry, Martin-Luther University of Halle-Wittenberg, Hollystr. 1, 06114 Halle (Saale), Germany.
| | - Rüdiger Horstkorte
- Institute for Physiological Chemistry, Martin-Luther University of Halle-Wittenberg, Hollystr. 1, 06114 Halle (Saale), Germany.
| | - Faramarz Dehghani
- Department of Anatomy and Cell Biology, Martin-Luther University of Halle-Wittenberg, Große Steinstraße 52, 06108 Halle (Saale), Germany.
| | - Christian Scheller
- Department of Neurosurgery, Martin-Luther University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
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21
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Sridharan SS, Rosen CA, Smith LJ, Young VN, Munin MC. Timing of nimodipine therapy for the treatment of vocal fold paralysis. Laryngoscope 2014; 125:186-90. [DOI: 10.1002/lary.24903] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/16/2014] [Accepted: 08/04/2014] [Indexed: 11/09/2022]
Affiliation(s)
| | - Clark A. Rosen
- Department of Otolaryngology; University of Pittsburgh Voice Center
| | - Libby J. Smith
- Department of Otolaryngology; University of Pittsburgh Voice Center
| | - VyVy N. Young
- Department of Otolaryngology; University of Pittsburgh Voice Center
| | - Michael C. Munin
- Department of Physical Medicine and Rehabilitation; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
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22
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Rosen CA, Smith L, Young V, Krishna P, Muldoon MF, Munin MC. Prospective investigation of nimodipine for acute vocal fold paralysis. Muscle Nerve 2014; 50:114-8. [PMID: 24639294 DOI: 10.1002/mus.24111] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 10/21/2013] [Accepted: 10/28/2013] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Nimodipine has been shown to be beneficial for recovery from acute vocal fold paralysis (AVFP) in an animal model. METHODS prospective, open-label trial of patients with AVFP was performed using nimodipine. Consecutive patients were evaluated and offered nimodipine therapy. RESULTS Fifty-three patients were considered for treatment with nimodipine. Thirteen did not qualify for inclusion, 5 were lost to follow-up, and 7 had side effects requiring cessation of treatment. Thus 28 patients (30 paralyzed vocal folds) were analyzed. Eighteen of the paralyzed vocal folds experienced recovery of purposeful motion (60%). Historical controls and laryngeal electromyography meta-analysis suggest no more than a 20% recovery rate from AVFP. CONCLUSIONS This open label study using nimodipine for treatment of AVFP demonstrates tripling of the recovery rate of vocal fold motion compared with historical controls. Further study in a randomized, controlled manner is warranted.
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Affiliation(s)
- Clark A Rosen
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh School of Medicine, UPMC Mercy Building B, Suite 11500, 1400 Locust Street, Pittsburgh, Pennsylvania, 15219, USA
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23
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Li M, Chen S, Wang W, Chen D, Zhu M, Liu F, Zhang C, Li Y, Zheng H. Effect of duration of denervation on outcomes of ansa-recurrent laryngeal nerve reinnervation. Laryngoscope 2014; 124:1900-5. [PMID: 24473920 DOI: 10.1002/lary.24623] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/03/2014] [Accepted: 01/27/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Meng Li
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Shicai Chen
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Wei Wang
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Donghui Chen
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Minhui Zhu
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Fei Liu
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Caiyun Zhang
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Yan Li
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Hongliang Zheng
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
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24
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Scheller C. Pharmacological perioperative brain neuroprotection: nimodipine? Br J Anaesth 2014; 112:178-9. [DOI: 10.1093/bja/aet459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Devesa J, Reimunde P, Devesa P, Barberá M, Arce V. Growth hormone (GH) and brain trauma. Horm Behav 2013; 63:331-44. [PMID: 22405763 DOI: 10.1016/j.yhbeh.2012.02.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 02/21/2012] [Accepted: 02/22/2012] [Indexed: 12/27/2022]
Abstract
Growth hormone (GH) is a pleiotropic hormone with known neurotrophic effects. We aimed to study whether GH administration might be useful together with rehabilitation in the recovery of TBI patients. 13 TBI patients (8 M, 5 F; age: 6-53 years old) were studied. Time after TBI: 2.5 months to 11 years; 5 patients showed acquired GH-deficiency (GHD). Disabilities observed: cognitive disorders; motor plegias; neurogenic dysphagia (n=5), vegetative coma (n=2) and amaurosis (n=1). All but one TBI patient followed intense rehabilitation for years. Treatment consisted of GH administration (maximal dose 1 mg/day, 5 days/week, resting 15-days every 2-months, until a maximum of 8 months) and clinical rehabilitation according to the individual needs (3-4 h/day, 5 days/week, during 6-12 months). Informed consent was obtained before commencing GH administration. GH significantly increased plasma IGF-1 values (ng.mL(-1)) in both GHD and no GHD patients, being then similar between both groups (GHD: 275.6±35.6 [p<0.01 vs. baseline], no GHD: 270.2±64 [p<0.05 vs. baseline]). In all the cases clear significant improvements were observed during and at the end of the combined treatment. Cognitive improvements appeared earlier and were more important than motor improvements. Swallowing improved significantly in all TBI patients with neurogenic dysphagia (2 of them in a vegetative state). Visual performance was ameliorated in the patient with amaurosis. No undesirable side-effects were observed. Our data indicate that GH can be combined with rehabilitation for improving disabilities in TBI patients, regardless of whether or not they are GHD.
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Affiliation(s)
- Jesús Devesa
- Department of Physiology, School of Medicine, University of Santiago de Compostela, Spain.
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Nishimoto K, Kumai Y, Sanuki T, Minoda R, Yumoto E. The impact of nimodipine administration combined with nerve-muscle pedicle implantation on long-term denervated rat thyroarytenoid muscle. Laryngoscope 2012; 123:952-9. [PMID: 22965496 DOI: 10.1002/lary.23698] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the impact of nimodipineon reinnervation of the long-term denervated rat thyroarytenoid (TA) muscle following nerve-muscle pedicle flap (NMP) implantation. STUDY DESIGN Quantitative histologic and physiologic assessments. METHODS Using 120 Wistar rats, we performed NMP implantation at different times after transection of the left recurrent laryngeal nerve (RLN). Sixty animals received nimodipine treatment (NIMO [+] group), and the remaining 60 animals received no nimodipine treatment (NIMO [-] group). As a control, an additional 28 animals were subjected only to transection of the left RLN (DNV group). Subgroups were assigned based on the period after RLN transection (0 [immediate], 8, 16, and 32 weeks). In the DNV group, we assessed histologically the muscle area, axons, neuromuscular junctions (NMJs), and myosin heavy chains (MyHC) type IIA and IIB in the TA muscle. In the NIMO (-) and NIMO (+) groups, histologic assessments and evoked electromyography were performed on the TA muscle at 10 weeks post-NMP implantation. RESULTS In 8-week interval subgroups, the muscle fiber area and the number of NMJs in the NIMO (+) group were significantly greater than in the NIMO (-) group (P < 0.05, each). In the 0-week and 32-week interval subgroups, the muscle fiber subtype changed significantly, from IIA to IIB (P < 0.01 and P < 0.05, respectively); and, at all time-points the muscle fiber area, number of NMJs, and action potentials in the TA muscle tended to be greater in the NIMO (+) group than in the NIMO (-) group. CONCLUSIONS Nimodipine expedited the effects of NMP implantation on reinnervation of the long-term denervated TA muscle. Laryngoscope, 2012.
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Affiliation(s)
- Kohei Nishimoto
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University, Graduate School of Medicine, Kumamoto, Japan.
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Weissbrod P, Pitman MJ, Sharma S, Bender A, Schaefer SD. Quantity and three-dimensional position of the recurrent and superior laryngeal nerve lower motor neurons in a rat model. Ann Otol Rhinol Laryngol 2012; 120:761-8. [PMID: 22224319 DOI: 10.1177/000348941112001111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We sought to elucidate the 3-dimensional position and quantify the lower motor neurons (LMNs) of the recurrent laryngeal nerve (RLN) and the superior laryngeal nerve (SLN) in a rat model. Quantification and mapping of these neurons will enhance the usefulness of the rat model in the study of reinnervation following trauma to these nerves. METHODS Female Sprague-Dawley rats underwent microsurgical transection of the RLN, the SLN, or both the RLN and SLN or sham surgery. After transection, either Fluoro-Ruby (FR) or Fluoro-Gold (FG) was applied to the proximal nerve stumps. The brain stems were harvested, sectioned, and examined for fluorolabeling. The LMNs were quantified, and their 3-dimensional position within the nucleus ambiguus was mapped. RESULTS Labeling of the RLN was consistent regardless of the labeling agent used. A mean of 243 LMNs was documented for the RLN. The SLN labeling with FR was consistent and showed a mean of 117 LMNs; however, FG proved to be highly variable in labeling the SLN. The SLN LMNs lie rostral and ventral to those of the RLN. In the sham surgical condition, FG was noted to contaminate adjacent tissues--in particular, in the region of the SLN. CONCLUSIONS Fluorolabeling is an effective tool to locate and quantify the LMNs of the RLN and SLN. The LMN positions and counts were consistent when FR was used in labeling of either the RLN or the SLN. Fluoro-Gold, however, because of its tendency to contaminate surrounding structures, can only be used to label the RLN. Also, as previously reported, the SLN LMNs lie rostral and ventral to those of the RLN. This information results in further clarification of a rat model of RLN injury that may be used to investigate the effects of neurotrophic factors on RLN reinnervation.
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Affiliation(s)
- Philip Weissbrod
- Department of Otolaryngology, New York Eye and Ear Infirmary, New York, NY 10003. USA
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Nishimoto K, Kumai Y, Minoda R, Yumoto E. Nimodipine accelerates reinnervation of denervated rat thyroarytenoid muscle following nerve-muscle pedicle implantation. Laryngoscope 2012; 122:606-13. [DOI: 10.1002/lary.22487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/11/2011] [Indexed: 01/24/2023]
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Attenuation of proinflammatory cytokines and apoptotic process by verapamil and diltiazem against quinolinic acid induced Huntington like alterations in rats. Brain Res 2011; 1372:115-26. [DOI: 10.1016/j.brainres.2010.11.060] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/15/2010] [Accepted: 11/18/2010] [Indexed: 01/22/2023]
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Pitman MJ, Weissbrod P, Roark R, Sharma S, Schaefer SD. Electromyographic and histologic evolution of the recurrent laryngeal nerve from transection and anastomosis to mature reinnervation. Laryngoscope 2011; 121:325-31. [DOI: 10.1002/lary.21290] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
PURPOSE OF REVIEW This review will discuss recent progress in experimental and translational research related to surgical repair of proximal nerve root injuries, and emerging potential therapies, which may be combined with replantation surgeries to augment functional outcomes after brachial plexus and cauda equina injuries. RECENT FINDINGS Progress in experimental studies of root and peripheral nerve injuries has identified potential candidates for adjunctive therapies, which may be combined with surgical replantation of avulsed roots after brachial plexus and cauda equina injuries. We will discuss recent advances related to adjunctive neuroprotective strategies, neurotrophic factor delivery, and emerging cellular treatment strategies after extensive nerve root trauma. We will also provide an update on electrical stimulation to promote regenerative axonal growth and new insights on the recovery of sensory functions after root injury and repair. SUMMARY In the light of recent advances in experimental studies, we envision that future repair of brachial plexus and cauda equina injuries will include spinal cord surgery to restore motor and sensory trajectories and a variety of adjunctive therapies to augment the recovery of neurological function.
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Lindsay RW, Heaton JT, Edwards C, Smitson C, Hadlock TA. Nimodipine and acceleration of functional recovery of the facial nerve after crush injury. ACTA ACUST UNITED AC 2010; 12:49-52. [PMID: 20083741 DOI: 10.1001/archfacial.2009.95] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To establish whether nimodipine, a calcium channel blocker, accelerates or otherwise improves functional recovery of whisking after facial nerve crush injury in the rat. METHODS Thirty rats underwent exposure of the left main trunk of the facial nerve followed by a standard crush injury and subsequent quantitative facial movement testing. Animals were randomized into an experimental group (n = 15) and a control group (n = 15). Four days prior to facial nerve manipulation, experimental animals underwent subcutaneous implantation of a nimodipine-secreting pellet. All animals were tested preoperatively and on postoperative days 2, 8 to 17, 20, 22, 24, and 31 using a validated, quantitative whisking kinematics apparatus. Whisks were analyzed for amplitude, velocity, and acceleration. RESULTS Animals receiving nimodipine demonstrated significantly better whisking on 5 days (postoperative days 9, 11 to 13, and 20) compared with control animals (P < .001, P = .003, P = .009, P = .009, and P = .009, respectively; 1-tailed ttest). Overall, the nimodipine-treated animals showed earlier recovery compared with the untreated animals. CONCLUSIONS We demonstrate that nimodipine improves recovery of whisking after facial nerve crush. This finding corroborates the semiquantitative findings of others, and provides complete whisking kinematic data on its effects. Given the low adverse effect profile of nimodipine, there may be clinical implications in its administration in patients experiencing facial nerve injury.
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Affiliation(s)
- Robin W Lindsay
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, USA.
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Bhama PK, Hillel AD, Merati AL, Perkel DJ. A novel model for examining recovery of phonation after vocal nerve damage. J Voice 2010; 25:275-82. [PMID: 20189348 DOI: 10.1016/j.jvoice.2009.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Accepted: 11/10/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recurrent laryngeal nerve injury remains a dominant clinical issue in laryngology. To date, no animal model of laryngeal reinnervation has offered an outcome measure that can reflect the degree of recovery based on vocal function. We present an avian model system for studying recovery of learned vocalizations after nerve injury. STUDY DESIGN Prospective animal study. METHODS Digital recordings of bird song were made from 11 adult male zebra finches; nine birds underwent bilateral crushing of the nerve supplying the vocal organ, and two birds underwent sham surgery. Songs from all the birds were then recorded regularly and analyzed based on temporal and spectral characteristics using computer software. Indices were calculated to indicate the degree of similarity between preoperative and postoperative song. RESULTS Nerve crush caused audible differences in song quality and significant drops (P<0.05) in measured spectral and, to a lesser degree, temporal indices. Spectral indices recovered significantly (mean=43.0%; standard deviation [SD]=40.7; P<0.02), and there was an insignificant trend toward recovery of temporal index (mean=28.0%; SD=41.4; P=0.0771). In five of the nine (56%) birds, there was a greater than 50% recovery of spectral indices within a 4-week period. Two birds exhibited substantially less recovery of spectral indices and two birds had a persistent decline in spectral indices. Recovery of temporal index was highly variable as well, ranging from persistent further declines of 45.1% to recovery of 87%. Neither sham bird exhibited significant (P>0.05) differences in song after nerve crush. CONCLUSION The songbird model system allows functional analysis of learned vocalization after surgical damage to vocal nerves.
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Affiliation(s)
- Prabhat K Bhama
- Department of Otolaryngology-Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
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McRae BR, Kincaid JC, Illing EA, Hiatt KK, Hawkins JF, Halum SL. Local neurotoxins for prevention of laryngeal synkinesis after recurrent laryngeal nerve injury. Ann Otol Rhinol Laryngol 2010; 118:887-93. [PMID: 20112524 DOI: 10.1177/000348940911801210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Persistent vocal fold motion impairment after recurrent laryngeal nerve (RLN) injury is not characteristically due to absent reinnervation, but often results from spontaneous aberrant reinnervation (synkinesis). We administered local neurotoxins to selected laryngeal muscles after RLN injury to determine whether aberrant reinnervation could be selectively inhibited. METHODS Unilateral RLN transection was performed in 24 male rats. Three weeks later, the denervated laryngeal adductor complex was injected with phenol, high- or low-dose vincristine sulfate (VNC), or saline solution. One month later, rat larynges were evaluated via videolaryngoscopy and laryngeal electromyography (LEMG). Larynges from euthanized animals were analyzed via immunofluorescent staining for the presence of reinnervation. RESULTS One animal that received phenol and 3 animals that received high-dose VNC died of toxicity-related complications. In the surviving neurotoxin-treated animals, videolaryngoscopy showed increased lateralization of the immobile vocal fold. Only 1 phenol-injected rat had adductor complex motor recruitment (score of 3+) with LEMG. The other neurotoxin-treated animals demonstrated an absence of adductor complex reinnervation, with only insertional activity and fibrillations (no motor units/recruitment). Spontaneous ipsilateral abductor reinnervation was not affected by the adductor injections. CONCLUSIONS Low-dose VNC injections appear to be relatively safe and effective in selectively inhibiting spontaneous aberrant reinnervation after RLN injury in an animal model.
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Affiliation(s)
- Bryan R McRae
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis 46202, USA
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Lindsay RW, Heaton JT, Edwards C, Smitson C, Hadlock TA. Nimodipine and Acceleration of Functional Recovery of the Facial Nerve
After Crush Injury. ACTA ACUST UNITED AC 2010. [DOI: 10.1001/archfaci.2009.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Robin W. Lindsay
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston (Drs Lindsay and Hadlock and Mssrs Edwards and Smitson), Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Heaton); and Department of Otolaryngology–Head and Neck Surgery, National Naval Medical Center, Bethesda, Maryland (Dr Lindsay)
| | - James T. Heaton
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston (Drs Lindsay and Hadlock and Mssrs Edwards and Smitson), Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Heaton); and Department of Otolaryngology–Head and Neck Surgery, National Naval Medical Center, Bethesda, Maryland (Dr Lindsay)
| | - Colin Edwards
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston (Drs Lindsay and Hadlock and Mssrs Edwards and Smitson), Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Heaton); and Department of Otolaryngology–Head and Neck Surgery, National Naval Medical Center, Bethesda, Maryland (Dr Lindsay)
| | - Christopher Smitson
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston (Drs Lindsay and Hadlock and Mssrs Edwards and Smitson), Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Heaton); and Department of Otolaryngology–Head and Neck Surgery, National Naval Medical Center, Bethesda, Maryland (Dr Lindsay)
| | - Tessa A. Hadlock
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston (Drs Lindsay and Hadlock and Mssrs Edwards and Smitson), Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Heaton); and Department of Otolaryngology–Head and Neck Surgery, National Naval Medical Center, Bethesda, Maryland (Dr Lindsay)
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Tessema B, Roark RM, Pitman MJ, Weissbrod P, Sharma S, Schaefer SD. Observations of recurrent laryngeal nerve injury and recovery using a rat model. Laryngoscope 2009; 119:1644-51. [DOI: 10.1002/lary.20293] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hydman J, Björck G, Persson JKE, Zedenius J, Mattsson P. Diagnosis and Prognosis of Iatrogenic Injury of the Recurrent Laryngeal Nerve. Ann Otol Rhinol Laryngol 2009; 118:506-11. [DOI: 10.1177/000348940911800709] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Following perioperative injury to a macroscopically intact recurrent laryngeal nerve (RLN), there are two possible intraneural injury types: 1) axonal injury, including disruption of axons, and 2) conduction block, only affecting the Schwann cells and the nodes of Ranvier. In this study, it was hypothesized that the functional outcome after RLN injury may depend on the type of nerve injury. Methods: Fifteen patients with acute postoperative unilateral RLN paralysis were prospectively studied. Electrophysiological examination (laryngeal electromyography) was used to differentiate between the two types of nerve injury. Vocal fold motions were monitored by repeated laryngoscopy during the study period (up to 6 months). Three of the patients with axonal injury were treated with the regeneration-promoting agent nimodipine. Results: The patients with conduction block all recovered normal vocal fold motion, whereas patients with axonal injury within the nerve had a significantly worse outcome. The 3 patients who were treated with nimodipine all recovered normal or near-normal vocal fold mobility despite the more severe axonal injury. Conclusions: In contrast to previous reports, our results show that laryngeal electromyography is a reliable tool for diagnosing the type of injury within the injured RLN, making it possible to predict the functional outcome in these patients. On the basis of the results, a future randomized study on nimodipine treatment for RLN axonal injury is suggested.
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Hydman J, Mattsson P. Preserved Regeneration and Functional Recovery of the Injured Recurrent Laryngeal Nerve after Secondary Surgical Repair in Adult Rats. Ann Otol Rhinol Laryngol 2009; 118:73-80. [DOI: 10.1177/000348940911800112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Transection of the recurrent laryngeal nerve (RLN) is accompanied by poor functional recovery, despite primary repair, because of regeneration difficulties. Nimodipine can promote regeneration, but it is not yet clear whether preoperative treatment is necessary. It is also not clear whether surgical repair following RLN injury may be performed in a second procedure, with preserved regeneration. This study investigated the time window for secondary surgical repair of the transected RLN and the need for preoperative administration of nimodipine. Methods: In adult rats, the left RLN was transected and repaired at time intervals up to 3 weeks after transection, in combination with nimodipine treatment starting either before or after the operation. Regeneration and neuromuscular recovery were assessed by electrophysiology, retrograde tracing, and immunohistochemistry. Results: Similar (whether 0, 2, or 7 days) regenerative results were obtained when the RLN was repaired up to 1 week after injury, given nimodipine administration, whereas fewer motor neurons managed to regenerate after nerve repair at 3 weeks after the initial transection. No beneficial effect was detected from preoperative nimodipine administration. Conclusions: Provided that nimodipine is administered, surgical reconstruction of the RLN can be performed within 1 week after the initial nerve trauma, with preserved neuromuscular function. Nimodipine may be administered at the time of RLN transection injury.
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Protective Effect of L-type Calcium Channel Blockers Against Haloperidol-induced Orofacial Dyskinesia: A Behavioural, Biochemical and Neurochemical Study. Neurochem Res 2008; 33:1869-80. [DOI: 10.1007/s11064-008-9660-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Accepted: 03/07/2008] [Indexed: 12/25/2022]
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