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Case Reports
. 2021 May;44(3):425-428.
doi: 10.1080/10790268.2019.1585706. Epub 2019 Mar 18.

Thoracoscopic intercostal to phrenic nerve transfer for diaphragmatic reanimation in a child with tetraplegia

Jacob Latreille  1 , Erika B Lindholm  2 , Dan A Zlotolow  3 , Harsh Grewal  2   3
Affiliations
Case Reports

Thoracoscopic intercostal to phrenic nerve transfer for diaphragmatic reanimation in a child with tetraplegia

Jacob Latreille et al. J Spinal Cord Med. 2021 May.

Abstract

Context: To describe for the first time a novel technique of thoracoscopic intercostal nerve mobilization and intercostal to phrenic nerve transfer in the setting of tetraplegia with the goal of reanimating the diaphragm and decreasing ventilator dependence.Findings: A 5-year-old female on 24 h ventilator support secondary to traumatic tetraplegia was evaluated for possible phrenic nerve pacing. Left-sided phrenic nerve stimulation did not result in diaphragmatic contraction indicating a lower motor neuron injury. The patient underwent thoracoscopic mobilization of the left phrenic nerve and 10th intercostal nerve while positioned in the left lateral decubitus position using four 5 mm trocars. The mobilized intercostal nerve was transected close to its distal anterior termination and coapted without tension to the cut end of the terminal phrenic nerve using fibrin sealant. Lastly, phrenic nerve pacer leads and battery were implanted in the chest wall and connected to the electrode placed on the intercostal nerve. One year following the procedure, the patient was tolerating phrenic pacing during the day while requiring ventilation overnight. Currently, the patient is 2 years post-operative from this procedure and does not require ventilator support.Conclusion/clinical relevance: We have shown for the first time a novel approach of thoracoscopic nerve mobilization and phrenic to intercostal nerve transposition to be both safe and effective for restoring innervation of the diaphragm in a child. This minimally invasive procedure is recommended as the preferred approach to reanimate the diaphragm.

Keywords: Diaphragmatic reanimation; Nerve pacing; Phrenic nerve transfer; Traumatic tetraplegia.

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Figures

Figure 1.
Figure 1.
Thoracoscopic mobilization of (A) the 10th intercostal nerve (arrow) off of the chest wall, and (B) the phrenic nerve (asterisk) off of the pericardium.
Figure 2.
Figure 2.
(A) The intercostal nerve (arrow) transferred to the left phrenic nerve (asterisk) without tension and (B) coaptation was secured with TISSEEL fibrin.
See this image and copyright information in PMC

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