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Lower cranial nerve responses after laryngeal stimulation in posterior fossa surgery: a study of medullary complex motor functions.

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Title: Lower cranial nerve responses after laryngeal stimulation in posterior fossa surgery: a study of medullary complex motor functions.
Authors: Pescador AM; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK. Electronic address: A.mirallave-pescador@nhs.net., Baamonde AD; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK., de Los Angeles Sanchez Roldan M; Department of Clinical, Neurophysiology Hospital Vall D'Hebron Barcelona, Spain., Ulkatan S; Mount Sinai West Hospital, New York City, NY, USA., Lejarde A; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK., Murace SE; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK., Lawson EC; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK., Lippolis M; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK., Bleil C; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK., Lavrador J; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK., Shapey J; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK., Leote J; Department of Neurosurgery, Unidade Local de Saude Almada Seixal, Almada, Portugal., Barazi S; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK., Zebian B; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK., Tellez MJ; Mount Sinai West Hospital, New York City, NY, USA.
Source: Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology [Clin Neurophysiol] 2026 Oct; Vol. 190, pp. 2112319. Date of Electronic Publication: 2026 Jun 23.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 100883319 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-8952 (Electronic) Linking ISSN: 13882457 NLM ISO Abbreviation: Clin Neurophysiol Subsets: MEDLINE
Imprint Name(s): Original Publication: Amsterdam : Elsevier, c1999-
MeSH Terms: Medulla Oblongata*/physiology , Intraoperative Neurophysiological Monitoring*/methods , Cranial Nerves*/physiology , Larynx*/physiology, Reflex/physiology ; Electric Stimulation/methods ; Tongue/physiology ; Tongue/innervation ; Palate, Soft/physiology ; Palate, Soft/innervation ; Deglutition/physiology ; Humans ; Female ; Male ; Middle Aged ; Adult ; Aged
Abstract: Objective: Complex motor responses (CMRs) can be recorded from lower cranial nerves after laryngeal stimulation. Long latency responses (LLRs) are observed in the soft palate and tongue. This study aimed to describe these responses, evaluate their intraoperative reproducibility, and assess correlations between signal loss and postoperative outcomes.
Methods: The laryngeal adductor reflex (LAR) was elicited while LLRs were recorded bilaterally from the soft palate and tongue. Permanent signal loss was defined as an amplitude reduction greater than 50% affecting two LLRs. Postoperative outcomes were then analysed.
Results: LLRs were recorded in 50% of tongue recordings and 47.8% of soft palate recordings, compared with a 92% detection rate for LAR. Significant associations were found between postoperative swallowing deficits and true positive permanent LLR signal changes. The odds ratio was 22.2 (95% CI: 3.5-141). Positive and negative likelihood ratios for swallowing outcomes were 6.30 and 0.28, respectively.
Conclusion: LLRs provide a novel method to monitor cranial nerves IX, X and XII within an integrated medullary network, acting as coordinated bulbar motor sequences. While they may offer a practical surrogate marker for complex motor functions like swallowing, their preservation primarily suggests the structural integrity of these shared brainstem pathways.
Significance: Our study demonstrates the reproducibility of CMRs after laryngeal stimulation in asleep patients. These results may be useful for monitoring medullary complex motor functions of the brainstem.
(Copyright © 2026 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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.
Contributed Indexing: Keywords: Brainstem reflex monitoring; Complex motor central pattern generators of the brainstem; Swallowing
Entry Date(s): Date Created: 20260626 Date Completed: 20260812 Latest Revision: 20260812
Update Code: 20260813
DOI: 10.1016/j.clinph.2026.2112319
PMID: 42361556
Database: MEDLINE
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  Data: Lower cranial nerve responses after laryngeal stimulation in posterior fossa surgery: a study of medullary complex motor functions.
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  Data: <searchLink fieldCode="AU" term="%22Pescador+AM%22">Pescador AM</searchLink>; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK. Electronic address: A.mirallave-pescador@nhs.net.<br /><searchLink fieldCode="AU" term="%22Baamonde+AD%22">Baamonde AD</searchLink>; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.<br /><searchLink fieldCode="AU" term="%22de+Los+Angeles+Sanchez+Roldan+M%22">de Los Angeles Sanchez Roldan M</searchLink>; Department of Clinical, Neurophysiology Hospital Vall D'Hebron Barcelona, Spain.<br /><searchLink fieldCode="AU" term="%22Ulkatan+S%22">Ulkatan S</searchLink>; Mount Sinai West Hospital, New York City, NY, USA.<br /><searchLink fieldCode="AU" term="%22Lejarde+A%22">Lejarde A</searchLink>; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.<br /><searchLink fieldCode="AU" term="%22Murace+SE%22">Murace SE</searchLink>; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.<br /><searchLink fieldCode="AU" term="%22Lawson+EC%22">Lawson EC</searchLink>; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.<br /><searchLink fieldCode="AU" term="%22Lippolis+M%22">Lippolis M</searchLink>; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.<br /><searchLink fieldCode="AU" term="%22Bleil+C%22">Bleil C</searchLink>; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.<br /><searchLink fieldCode="AU" term="%22Lavrador+J%22">Lavrador J</searchLink>; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.<br /><searchLink fieldCode="AU" term="%22Shapey+J%22">Shapey J</searchLink>; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.<br /><searchLink fieldCode="AU" term="%22Leote+J%22">Leote J</searchLink>; Department of Neurosurgery, Unidade Local de Saude Almada Seixal, Almada, Portugal.<br /><searchLink fieldCode="AU" term="%22Barazi+S%22">Barazi S</searchLink>; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.<br /><searchLink fieldCode="AU" term="%22Zebian+B%22">Zebian B</searchLink>; Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.<br /><searchLink fieldCode="AU" term="%22Tellez+MJ%22">Tellez MJ</searchLink>; Mount Sinai West Hospital, New York City, NY, USA.
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  Data: <searchLink fieldCode="JN" term="%22100883319%22">Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology</searchLink> [Clin Neurophysiol] 2026 Oct; Vol. 190, pp. 2112319. <i>Date of Electronic Publication: </i>2026 Jun 23.
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Elsevier%22">Elsevier </searchLink><i>Country of Publication: </i>Netherlands <i>NLM ID: </i>100883319 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1872-8952 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2213882457%22">13882457 </searchLink><i>NLM ISO Abbreviation: </i>Clin Neurophysiol <i>Subsets: </i>MEDLINE
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  Data: <i>Original Publication</i>: Amsterdam : Elsevier, c1999-
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  Data: <searchLink fieldCode="MM" term="%22Medulla+Oblongata%22">Medulla Oblongata*</searchLink>/<searchLink fieldCode="MM" term="%22Medulla+Oblongata+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring%22">Intraoperative Neurophysiological Monitoring*</searchLink>/<searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Cranial+Nerves%22">Cranial Nerves*</searchLink>/<searchLink fieldCode="MM" term="%22Cranial+Nerves+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Larynx%22">Larynx*</searchLink>/<searchLink fieldCode="MM" term="%22Larynx+physiology%22">physiology</searchLink><br /><searchLink fieldCode="MH" term="%22Reflex%22">Reflex</searchLink>/<searchLink fieldCode="MH" term="%22Reflex+physiology%22">physiology</searchLink> ; <searchLink fieldCode="MH" term="%22Electric+Stimulation%22">Electric Stimulation</searchLink>/<searchLink fieldCode="MH" term="%22Electric+Stimulation+methods%22">methods</searchLink> ; <searchLink fieldCode="MH" term="%22Tongue%22">Tongue</searchLink>/<searchLink fieldCode="MH" term="%22Tongue+physiology%22">physiology</searchLink> ; <searchLink fieldCode="MH" term="%22Tongue%22">Tongue</searchLink>/<searchLink fieldCode="MH" term="%22Tongue+innervation%22">innervation</searchLink> ; <searchLink fieldCode="MH" term="%22Palate%2C+Soft%22">Palate, Soft</searchLink>/<searchLink fieldCode="MH" term="%22Palate%2C+Soft+physiology%22">physiology</searchLink> ; <searchLink fieldCode="MH" term="%22Palate%2C+Soft%22">Palate, Soft</searchLink>/<searchLink fieldCode="MH" term="%22Palate%2C+Soft+innervation%22">innervation</searchLink> ; <searchLink fieldCode="MH" term="%22Deglutition%22">Deglutition</searchLink>/<searchLink fieldCode="MH" term="%22Deglutition+physiology%22">physiology</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%22">Aged</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Complex motor responses (CMRs) can be recorded from lower cranial nerves after laryngeal stimulation. Long latency responses (LLRs) are observed in the soft palate and tongue. This study aimed to describe these responses, evaluate their intraoperative reproducibility, and assess correlations between signal loss and postoperative outcomes.<br />Methods: The laryngeal adductor reflex (LAR) was elicited while LLRs were recorded bilaterally from the soft palate and tongue. Permanent signal loss was defined as an amplitude reduction greater than 50% affecting two LLRs. Postoperative outcomes were then analysed.<br />Results: LLRs were recorded in 50% of tongue recordings and 47.8% of soft palate recordings, compared with a 92% detection rate for LAR. Significant associations were found between postoperative swallowing deficits and true positive permanent LLR signal changes. The odds ratio was 22.2 (95% CI: 3.5-141). Positive and negative likelihood ratios for swallowing outcomes were 6.30 and 0.28, respectively.<br />Conclusion: LLRs provide a novel method to monitor cranial nerves IX, X and XII within an integrated medullary network, acting as coordinated bulbar motor sequences. While they may offer a practical surrogate marker for complex motor functions like swallowing, their preservation primarily suggests the structural integrity of these shared brainstem pathways.<br />Significance: Our study demonstrates the reproducibility of CMRs after laryngeal stimulation in asleep patients. These results may be useful for monitoring medullary complex motor functions of the brainstem.<br /> (Copyright © 2026 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)
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  Data: 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.
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  Data: <i>Keywords: </i>Brainstem reflex monitoring; Complex motor central pattern generators of the brainstem; Swallowing
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      – TitleFull: Lower cranial nerve responses after laryngeal stimulation in posterior fossa surgery: a study of medullary complex motor functions.
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