{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T10:36:24Z","timestamp":1774694184238,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,12,24]],"date-time":"2018-12-24T00:00:00Z","timestamp":1545609600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>We report an association between lower cranial nerve (CN IX\/X) vascular compression at the brainstem with laryngeal symptoms utilizing a stepwise algorithm that systematically evaluates and eliminates all other common etiologies. Our experiences with retromastoid craniectomy with lower cranial nerve (LCN) decompression versus non\u2010neurosurgical treatments are detailed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective chart review at a tertiary care academic medical center with follow\u2010up telephone survey.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Baseline demographics, clinical characteristics, quality\u2010of\u2010life surveys, and treatment outcomes were recorded for patients with laryngeal symptoms associated with LCN compression at the brainstem.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010nine patients demonstrated LCN compression at the brainstem on imaging and presented with chief complaints of dysphonia (25 of 49, 51%), chronic cough (19 of 49, 39%), dysphoric breathing (3 of 49, 6%), and dysphagia (2 of 49, 4%). Poor initial scores were noted for Voice\u2010Related Quality of Life (V\u2010RQOL), Reflux Symptom Index, and Glottal Closure Index. Twenty\u2010four patients underwent LCN decompression, of which 21 of 24 (88%) reported partial, near\u2010complete, or complete improvement. Major perioperative complications occurred in four of 24 patients (17%). Patients who had undergone decompression were more likely to obtain complete\/near\u2010complete symptom resolution (10 of 24 patients, 42%) compared to those undergoing conservative treatments (2 of 25 patients, 8%) (<jats:italic>P<\/jats:italic>\u2009=\u20090.02). V\u2010RQOL scores improved more in surgical patients [mean change score, 33.0 (standard deviation [SD], 31.2) than nonsurgical patients (mean change score 9.6, SD 20.9) (<jats:italic>P<\/jats:italic>\u2009=\u20090.03) (mean follow\u2010up 3.0 years, SD 2.0).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Lower cranial nerve compression at the brainstem should be considered when all other etiologies are excluded. Retromastoid craniectomy with LCN decompression demonstrates an acceptable safety profile.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4<\/jats:p><jats:p><jats:italic>Laryngoscope<\/jats:italic>, 129:2105\u20132111, 2019<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27678","type":"journal-article","created":{"date-parts":[[2018,12,24]],"date-time":"2018-12-24T08:31:29Z","timestamp":1545640289000},"page":"2105-2111","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Laryngeal manifestations of cranial nerve IX\/X compression at the brainstem"],"prefix":"10.1002","volume":"129","author":[{"given":"Robert J.","family":"Taylor","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Medical University of South Carolina Charleston South Carolina U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen R.","family":"Lowe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Medical University of South Carolina Charleston South Carolina U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nic","family":"Ellis","sequence":"additional","affiliation":[{"name":"College of Medicine Medical University of South Carolina Charleston South Carolina U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Medical University of South Carolina Charleston South Carolina U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Medical University of South Carolina Charleston South Carolina U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucinda A.","family":"Halstead","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Medical University of South Carolina Charleston South Carolina 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