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Tytuł:
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The terminal segment of the human phrenic nerve as a novel implantation site for diaphragm pacing electrodes: Anatomical and clinical description.
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Autorzy:
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Etienne H; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Tenon, Service de Chirurgie Thoracique, F-75013 Paris, France.
Gonzalez-Bermejo J; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Réhabilitation Respiratoire et Neuro-Respiratoire (Département R3S), F-75013 Paris, France.
Dres M; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France.
Maisonobe T; AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Site Pitié-Salpêtrière, Laboratoire de Neuropathologie, F-75013 Paris, France.
Brochier G; AP-HP, Groupe Hospitalier APHP-Sorbonne Université, Site Pitié-Salpêtrière, Laboratoire de Neuropathologie, F-75013 Paris, France.
Wingertsmann L; Université de Paris, INSERM, UMRS1152, Plateforme de Morphologie, F-75018 Paris, France.
Thibaudeau O; Université de Paris, INSERM, UMRS1152, Plateforme de Morphologie, F-75018 Paris, France.
Masmoudi H; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France.
Assouad J; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Tenon, Service de Chirurgie Thoracique, F-75013 Paris, France.
Similowski T; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Département R3S, F-75013 Paris, France. Electronic address: .
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Źródło:
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Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft [Ann Anat] 2022 Jan; Vol. 239, pp. 151835. Date of Electronic Publication: 2021 Sep 23.
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Typ publikacji:
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Journal Article; Observational Study
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Język:
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English
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Imprint Name(s):
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Original Publication: Jena [Germany] ; New York : G. Fischer, c1992-
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MeSH Terms:
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Diaphragm*
Phrenic Nerve*/anatomy & histology
Cadaver ; Electrodes, Implanted ; Humans ; Pericardium
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Contributed Indexing:
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Keywords: Anatomy; Diaphragm; Diaphragm pacing; Phrenic nerve
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Entry Date(s):
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Date Created: 20210925 Date Completed: 20211130 Latest Revision: 20211130
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Update Code:
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20240105
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DOI:
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10.1016/j.aanat.2021.151835
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PMID:
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34562604
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Background: Diaphragm pacing allows certain ventilator-dependent patients to achieve weaning from mechanical ventilation. The reference method consists in implanting intrathoracic contact electrodes around the phrenic nerve during video-assisted thoracic surgery, which involves time-consuming phrenic nerve dissection with a risk of nerve damage. Identifying a phrenic segment suitable for dissection-free implantation of electrodes would constitute progress.
Study Design: This study characterizes a free terminal phrenic segment never fully described before. We conducted a cadaver study (n = 14) and a clinical observational study during thoracic procedures (n = 54).
Results: A free terminal phrenic segment was observed on both sides in 100% of cases, "jumping" from the pericardium to the diaphragm and measuring 60 mm [95% confidence interval; 48-63] and 72.5 mm [65-82] (right left, respectively; p = 0.0038; cadaver study). This segment rolled up on itself at end-expiration and became unravelled and elongated with diaphragm descent (clinical study). Three categories of fat pads were defined (type 1: pericardiophrenic bundle free of surrounding fat; type 2: single fatty fringe leaving the phrenic nerve visible until diaphragmatic entry; type 3: multiple fatty fringes masking the site of penetration of the phrenic nerve) that depended on body mass index (p = 0.001, clinical study). Hematoxylin-eosin and toluidine blue staining (cadaver study) showed that all of the phrenic fibers in the distal, pre-branching part of the terminal segment were contained within a single epineurium containing a variable number of fascicles (right: 1 [95%CI 0.65-4.01]; left 5 [3.37-7.63]; p = 0.03).
Conclusion: Diaphragm pacing through periphrenic electrodes positioned on the terminal phrenic segment should be tested.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2021 Elsevier GmbH. All rights reserved.)
