Vagus Nerve Monitoring During Skull Base Surgery: A Transnasal Nerve Monitoring Technique

Abstract

Objective: The vagus nerve is at risk during open resection of skull base tumors involving the high parapharyngeal space and infratemporal fossa, particularly with less invasive approaches where the superior exposure may be limited. Nerve monitoring using an endotracheal nerve monitoring system is well established for thyroid surgery. However, an oral endotracheal tube limits operative exposure of some skull base tumors either by being in the surgical field or by preventing full mobilization of the mandible with transcervical approaches. We describe the novel use of a commercially available nerve-monitoring endotracheal tube, which is placed transnasally during open skull base surgery for infratemporal fossa or high parapharyngeal space tumors.