The aim of this study was to compare the outcomes of four intraoperative monitoring approaches in order to compare their prognostic value in surgical complications of the facial nerve. This quasi-experimental study was conducted on 25 patients with Cerebellopontine Angle (CPA) tumors, who were hospitalized in the Valiasr Hospital, affiliated to the Arak University of Medical Sciences, Arak, Iran. The degree of the facial nerve paralysis was assessed based on the House-Brackmann (HB) facial nerve grading system. The Orbicularis oris and Oculi muscles were evaluated by electromyography (EMG) before and after the surgery. Monitoring the facial nerve was performed by the EMG, Facial Nerve Antidromic Potentials (FNAPs), Transcranial Electrical Stimulation (TES), and Brainstem Auditory Evoked Potentials (BAEPs) methods. The mean HB score was 0.36.6±5.83, indicating that the function of the facial muscle was abnormal in all the patients pre-surgery. The comparison of the four monitoring approaches six months after surgery showed that the predictive value of facial nerve TES was higher than the other approaches (P<0.005). Furthemroe, 4% of the patients showed normal function in the facial muscle after the surgery. In addition, 8%, 56%, and 32% of the patients had mild abnormalities, moderate to severe paralysis in the facial muscles, and severe facial nerve dysfunction, respectively. In summary, 36% of the patients showed a mild abnormalities in the follow-up period, and full recovery was observed in 28% of the cases. In conclusion, the transcranial motor evoked potential (TCMEP) is a useful method for monitoring the facial nerve during the surgery along with the continuous EMG recordings.
The therapeutic strategies currently used to treat chronic subdural hematoma (CSDH) include various methods such as craniotomy and twist drill or utilizing Burr hole. The present research seeks to make a clinical comparison between using one burr hole and two burr holes to treat CSDH. This is a randomized, double-blind clinical trial conducted on 70 patients suffering from CSDH candidated for using burr hole. The participants were divided into two equal groups and underwent treatment with 1 burr hole or 2 burr holes. The primary and secondary outcome variables were compared across the two groups prior to and 48 hours following the operation. A total number of 5 death cases were (7.14%) were reported among patients. 2 patients (5.71%) were in the 1 burr hole group, while 3 (8.57%) were in the 2 burr hole group (P = 0.514). The need for undergoing a secondary operation in the 2 burr holes group (1 case, i.e. 2.85%) was significantly less than what was reported in the other group (6 cases, i.e. 17.14%) (P = 0.012). The mean time of hospitalization (1 burr hole: 4.98, 2 burr holes: 3.1, P = 0.001), the pneumosephalus levels 48 hours following the operation (1 burr hole: 9.38, 2 burr holes: 5.91, P = 0.012) and hematoma levels 48 hours following the operation (1 burr hole: 41.57, 2 burr holes: 30.85, P = 0.0001) in the 2 burr holes group were significantly less than what were reported in the other group. 48 hours after the operation, the hematoma volume (1 burr hole: P= 0.031, 2 burr holes: P= 0.002) in both groups exhibited a significant reduction compared to what was observed before the operation. Using 1 or 2 burr holes are quite useful methods to treat CSDH patients. However, the clinical outcome of those patients in the 2 burr holes group was much more favorable.
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