| Background and Objective: Epilepsy is one of the common disorder which are harmful to our body. Refractory epilepsy is focal topic for neurosurgery dorctors because of troublesome therapy. The common operational methods are cortex resection, forehead resection, elective nucleus amygdalae, multi-cerebral pia mater, mesolobus incision, temporal lobe resection, impairing operation. Although these methods can control or reduce epilepsy seizure. Because they also bring many complications such as severe impairing, sequela etc. In clinic, the vagus nerve stimulating(VNS) operation have been done more. But they bring some complications such as hoarsensess, coughing, dysphagia, stomach ulcer. VNS are limited in left side, because right vagus nerve control atrionector. They may bring latent severe heart ill effect. And if it is failure, we can't do the next operation. Glossopharyngeal nerve and vagus nerve have similar conduction circuit. To determine the anatomical and surgical feasibility of placement of a stimulator around the nerve of Hering (HN; a branch of cranial nerve nine) in China. We previously determined the success of HN stimulation in controlling epileptiform activity in a rabbit model study. The present study assessed the ability to extrapolate the ease of surgical dissection and surrounding anatomy to humans.Methods: Sixteen chinese human cadavers (8male, 8 female) were studied. Eight specimens were male and eight female; ages ranged from 10 years to 80 years (mean 49 years, median 67 years). Surgical exposure of the HN was achieved in a manner analogous to exposure for carotid endarterectomy. The skin was along the palpable medial border of the sternocleidomastoid muscle; dissection was then carried deep through the platysma, medial to the sternocleidomastoid. The carotid sheath was exposed, and the bifurcation of the common carotid artery was identified. The HN was identified along the internal carotid artery (ICA). Specific related parameters were noted, including the size of the nerve, its position relative to the ICA, the length of HN below the mandibular angle available for stimulator placement and the distance relative to nearby structures [i.e. the superior edge of the thyroid cartilage (STC), common facial vein (CFV) and inferior margin of the superior cervical ganglion (SCG)]. Results: (1) All cadavers exhibited the HN bilaterally. The mean diameter was 1.0mm, with no significant difference between left and right sides. (2) The HN was always of equal caliber throughout its course, from its origination at the extracranial main ninth cranial nerve trunk to its termination at the carotid sinus. The nerve terminated at the carotid bifurcation in all cases. The HN occurred as a single branch, loosely adherent to the ICA, in all specimens examined. With respect to the ICA, the HN coursed anteromedially in 20 of 32 cases (62.5%), anteriorly in 10 of 32 cases (31.25%) and anterolaterally in 2 of 32 cases (6.25%). (3) The visible termination of the nerve at the carotid sinus was also evaluated with respect to three surrounding structures: the STC, CFV and inferior margin of the SCG. The STC was a mean 5.4mm below the nerve termination (ranging from 35mm below to 33mm above it). The CFV was a mean 3.0mm above the nerve termination (ranging from 10mm below to15 mm above it). With respect to the SCG, the HN termination was consistently inferior, at a distance ranging from 6 to 30mm (mean 14.7mm). (4) The more close to the base of the skull, the anatomic structure are more complicated. HN below the mandibular angle are superficial, easy to stripe and expose and also easy to implante stimulator. For the application in the surgical operation, we measure the distanse between HN and the mandibular angle. The mean distance for stimulator implantation of approximately 15mm (range 6-30mm). (5)The result above are analyzed by statistics. There are no significant difference between sides and between sex. Conclusion: This study indicates that the HN was clearly present and surgically access...
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