Unilateral change of laryngeal adductor reflex and hiccups resolution after removal of bulbar hemangioblastoma: is there a connection?

Intractable hiccups, although typically benign, occasionally present as a clinical challenge requiring deeper investigation. We report a case of persistent hiccups as the sole manifestation of a cystic hemangioblastoma within the medulla oblongata. Conventional hiccup treatments were ineffective, prompting surgical intervention. We employed intraoperative neurophysiological monitoring of the Laryngeal Adductor Reflex (LAR) during the procedure, revealing intriguing asymmetries in reflex responses. At the end of the surgical excision, we recorded a significant LAR decrease on the left side, without any changes in vocal corticobulbar potentials (vocal coMEPs). Postoperatively, the patient's hiccups ceased, leaving transient pharyngeal hypoesthesia. This case underscores the utility of LAR monitoring and vocal coMEPs in brainstem surgeries and discuss a potential link between post-surgical LAR reduction, and hiccup resolution. Our findings prompt further exploration of the complex neural mechanisms governing hiccups and their therapeutic implications in neurosurgery.