The Location of the Parasympathetic Fibres within the Vagus Nerve Rootlets: A Case Report and a Review of the Literature.

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Aisha Alkubaisi, Charles C J Dong, Christopher R Honey
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引用次数: 1

Abstract

The vagus nerve has motor, sensory, and parasympathetic components. Understanding the nerve's internal anatomy, its variations, and relationship to the glossopharyngeal nerve are crucial for neurosurgeons decompressing the lower cranial nerves. We present a case report demonstrating the location of the parasympathetic fibres within the vagus nerve rootlets. A 47-year-old woman presented with a 1-year history of medically refractory left-sided glossopharyngeal neuralgia and a more recent history of left-sided hemi-laryngopharyngeal spasm. magnetic resonance imaging showed her left posterior inferior cerebellar artery distorting the lower cranial nerves on the affected left side. The patient consented to microvascular decompression of the lower cranial nerves with possible sectioning of the glossopharyngeal and upper sensory rootlets of the vagus nerve. During surgery, electrical stimulation of the most caudal rootlet of the vagus nerve triggered profound bradycardia. None of the more rostral rootlets had a similar parasympathetic response. This case is the first demonstration, to our knowledge, of the location of the cardiac parasympathetic fibres within the human vagus nerve rootlets. This new understanding of the vagus nerve rootlets' distribution of pure sensory (most rostral), motor/sensory (more caudal), and parasympathetic (most caudal) fibres may lead to a better understanding and diagnosis of the vagal rhizopathies. Approximately 20% of patients with glossopharyngeal neuralgia also have paroxysmal cough. This could be due to the anatomical juxtaposition of the IXth cranial nerve with the rostral vagal rootlets with pure sensory fibres (which mediate a tickling sensation in the lungs). A subgroup of patients with glossopharyngeal neuralgia have neuralgia-induced syncope. The cause of this rare condition, "vago-glossopharyngeal neuralgia," has been debated since it was first described by Riley in 1942. Our case supports the theory that this neuralgia-induced bradycardia is reflexively mediated through the brainstem with afferent impulses in the IXth and efferent impulses in the Xth cranial nerve. The rarer co-occurrence of glossopharyngeal neuralgia with hemi-laryngopharyngeal spasm (as seen in this case) may be explained by the proximity of the IXth nerve with the more caudal vagus rootlets which have motor (and probably sensory) supply to the throat. Finally, if there is a vagal rhizopathy related to compression of its parasympathetic fibres, one would expect it to be at the most caudal rootlet of the vagus nerve.

Abstract Image

Abstract Image

迷走神经根内副交感神经纤维的位置:1例报告及文献复习。
迷走神经由运动神经、感觉神经和副交感神经组成。了解神经的内部解剖结构、变异以及与舌咽神经的关系对神经外科医生减压下颅神经至关重要。我们提出了一个病例报告,证明了迷走神经根内副交感神经纤维的位置。一位47岁的女性,有1年的医学难治性左侧舌咽神经痛史和最近的左侧半喉咽痉挛史。磁共振成像显示她的左小脑后下动脉扭曲了受累左侧的下颅神经。患者同意对下颅神经进行微血管减压,并可能切除舌咽部和迷走神经的上感觉根。在手术中,电刺激迷走神经最尾端的根引起深度心动过缓。没有一个吻侧的小根有类似的副交感神经反应。据我们所知,这个病例是第一次证明心脏副交感神经纤维在人类迷走神经根内的位置。这种对迷走神经根在纯感觉纤维(大部分吻侧)、运动/感觉纤维(大部分尾侧)和副交感神经纤维(大部分尾侧)分布的新认识可能有助于更好地理解和诊断迷走神经根病。大约20%的舌咽神经痛患者同时伴有阵发性咳嗽。这可能是由于第8颅神经与鼻侧迷走神经根与纯感觉纤维(在肺部介导挠痒感觉)的解剖并列。一个亚组的患者与舌咽神经痛有神经痛诱发晕厥。这种罕见疾病的病因是“迷走-舌咽神经痛”,自1942年莱利首次描述以来,一直存在争议。我们的病例支持这样的理论:这种神经痛引起的心动过缓是通过脑干反射性地介导的,脑干通过第6脑神经的传入冲动和第6脑神经的传出冲动。舌咽神经痛与半喉咽痉挛的罕见共存(如本例所见)可能是由于第8神经与更多的尾侧迷走神经根接近,这些神经根对喉咙有运动(也可能是感觉)供应。最后,如果有一种与副交感神经纤维受压有关的迷走神经根病,人们会认为它是在迷走神经最尾端的根。
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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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