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LAR & CoMEP Monitoring in Brainstem Surgery!

IONM for Posterior Fossa & Brainstem surgery, most brain surgery related IONM functional assessments use time tested Auditory Evoked Potentials or BAER along with Cranial nerve responses, also monitored is EMGs as routine.

Here is an interesting procedure in which the group utilized Laryngeal adductor reflex (LAR) & Motor Evoked Potentials of Vocal Muscles (CoMEP), continuous monitoring of LAR (LAR:-to assess both sensory and motor activities of Vagus nerve (Yes, you heard me right, Vagus is an exceptional cranial nerve that possess both sensory and motor fibers (besides 3 other CNs that are both motor and sensory, check the list of CNs and nerve complex in the Netters image below). as against carrying only one type either sensory or motor fibers in the cases of other cranial nerves!?). Total 53 patients underwent Cerebellar pontine angle and Brainstem surgeries, LAR and CoMEP responses continuously guided the surgeons, when abnormal activity or response was reported, the surgical course was altered or adjusted to prevent any permanent damage to CNs or brain areas around surgical site. Some of the surgical adjustment made using LAR and CoMEP responses enhanced the surgical outcome!.....

check out the whole article, it is a good Case report:

Neurophysiological monitoring of the laryngeal adductor reflex during cerebellar-pontine angle and brainstem surgery


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