Human vagus nerve branching in the cervical region.
Human vagus nerve branching in the cervical region.
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DOI：
10.1371/journal.pone.0118006
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Winkler D
中科院分区：
文献类型：
--
作者：
Hammer N;Glätzner J;Feja C;Kühne C;Meixensberger J;Planitzer U;Schleifenbaum S;Tillmann BN;Winkler D
迷走神经刺激越来越多地用于治疗癫痫、精神疾病和潜在的慢性心力衰竭。将迷走神经电极植入颈部迷走神经后，在不同频率下观察到副作用，如声音改变和呼吸困难或失去治疗效果。颈迷走神经分支可能是产生这些效应的部分原因。然而，迷走神经分支尚未在迷走神经刺激的上下文中描述。在颈动脉鞘中肉眼观察了35例（66侧）尸体供体的颈迷走神经分支。在X线成像确定颈椎迷走神经分支的椎体水平后，取出样品以组织学确认神经并计算颈椎迷走神经直径和横截面。29%的病例（26%单侧，3%双侧）观察到颈迷走神经分支，所有病例均经组织学证实。右侧分支（22%）比左侧分支（12%）更常见，发生在左侧第四和第五椎骨水平以及右侧第二至第五椎骨水平。无分支的迷走神经的直径（4.79 mm vs. 3.78 mm）和横截面（7.24 mm2 vs. 5.28 mm2）显著大于有分支的迷走神经。颈迷走神经分支比前面描述的要频繁得多。迷走神经分支的侧依赖性差异可能与迷走神经的不对称效应有关。当识别迷走神经的主干以植入电极时，应考虑颈部迷走神经分支，以最大限度地减少迷走神经刺激的潜在副作用或缺乏治疗益处。
Vagus nerve stimulation is increasingly applied to treat epilepsy, psychiatric conditions and potentially chronic heart failure. After implanting vagus nerve electrodes to the cervical vagus nerve, side effects such as voice alterations and dyspnea or missing therapeutic effects are observed at different frequencies. Cervical vagus nerve branching might partly be responsible for these effects. However, vagus nerve branching has not yet been described in the context of vagus nerve stimulation. Branching of the cervical vagus nerve was investigated macroscopically in 35 body donors (66 cervical sides) in the carotid sheath. After X-ray imaging for determining the vertebral levels of cervical vagus nerve branching, samples were removed to confirm histologically the nerve and to calculate cervical vagus nerve diameters and cross-sections. Cervical vagus nerve branching was observed in 29% of all cases (26% unilaterally, 3% bilaterally) and proven histologically in all cases. Right-sided branching (22%) was more common than left-sided branching (12%) and occurred on the level of the fourth and fifth vertebra on the left and on the level of the second to fifth vertebra on the right side. Vagus nerves without branching were significantly larger than vagus nerves with branches, concerning their diameters (4.79 mm vs. 3.78 mm) and cross-sections (7.24 mm2 vs. 5.28 mm2). Cervical vagus nerve branching is considerably more frequent than described previously. The side-dependent differences of vagus nerve branching may be linked to the asymmetric effects of the vagus nerve. Cervical vagus nerve branching should be taken into account when identifying main trunk of the vagus nerve for implanting electrodes to minimize potential side effects or lacking therapeutic benefits of vagus nerve stimulation.
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