A Novel Method in Predicting Immediate Postoperative Facial Nerve Function Post Acoustic Neuroma Excision

Lin, Vincent; Houlden, David A.; Bethune, Allison; Nolan, Meghan P.; Pirouzmand, Farhad; Rowed, David W.; Nedzelski, Julian M.; Chen, Joseph M.

doi:10.1097/01.mao.0000235308.87689.35

Cited by 20 publications

(19 citation statements)

References 16 publications

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“…The amplitude and threshold stimulation intensity of CMAP recordings can provide an objective measurement of the function of the facial nerve and are correlated with postoperative facial nerve outcomes. [18][19][20][21][22][23][24][25][26][27][28] In an illustrative prospective analysis of 74 consecutive VS patients, Neff et al 21 found that when considered together, a stimulus threshold of 0.05 mA and a response amplitude of 240 mV or greater predicted HB grade 1 or 2 function at 1 year after surgery with 98% probability. This technique, however, assesses only the functional integrity of the facial nerve between the site of direct stimulation and the innervated musculature.…”

Section: Discussionmentioning

confidence: 99%

Impact of Motor-Evoked Potential Monitoring on Facial Nerve Outcomes after Vestibular Schwannoma Resection

Tawfik

Walters

Kohlberg

et al. 2018

Ann Otol Rhinol Laryngol

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Objectives: Assess the utility of intraoperative transcranial facial motor-evoked potential (FMEP) monitoring in predicting and improving facial function after vestibular schwannoma (VS) resection. Study Design: Retrospective chart review. Methods: Data were obtained from 82 consecutive VS resections meeting inclusion criteria. Sixty-two cases were performed without FMEP and 20 with FMEP. Degradation of FMEP response was defined as a final-to-baseline amplitude ratio of 0.5 or less. House-Brackmann (HB) grade was assessed preoperatively, postoperatively, at follow-up assessments, and it was compared between pre-and post-FMEP cohorts. Positive predictive value (PPV) and negative predictive value (NPV), sensitivity, and specificity of FMEP degradation in predicting facial weakness were calculated. Results: In the pre-FMEP group, at length of follow-up (LOF) ⩾9 months, 83.9% (52/62) of patients exhibited HB 1-2 outcome. In the post-FMEP cohort, 75.0% (15/20) exhibited HB 1-2 function at LOF ⩾9 months. There was no difference in rates of HB 1-2 outcomes between groups in the immediate postoperative period (P = .35) or at long-term follow-up (P = 1.0). With respect to predicting immediate postoperative facial function, FMEP demonstrated high specificity (88.9%) and moderate sensitivity (54.5%). The PPV and NPV for immediate postoperative facial function were 85.7% and 61.5%, respectively. With respect to long-term (⩾9 months LOF) facial function, intraoperative FMEP was moderately sensitive (71.4%) and highly specific (84.6%); PPV was moderate (71.4%), and NPV was high (84.6%). Conclusions: Intraoperative FMEP is highly specific and moderately sensitive in predicting postoperative facial function for patients undergoing VS resection, but its use may not be associated with improved facial nerve outcomes.

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Section: Discussionmentioning

confidence: 99%

Impact of Motor-Evoked Potential Monitoring on Facial Nerve Outcomes after Vestibular Schwannoma Resection

Tawfik

Walters

Kohlberg

et al. 2018

Ann Otol Rhinol Laryngol

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“…The other purpose is that intermittent stimulation assures the surgeon that the nerve has been preserved distal to the stimulation site at a given time. Many authors have concluded that CMPAs elicited by electrical stimulation to the proximal (near the brainstem exit zone) of the facial nerve can predict postoperative facial nerve function 1 – 8. However, in surgery for large tumours, especially for large vestibular schwannomas, the use of electrical nerve stimulation is clearly limited during the early steps of dissection.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative monitoring of compound muscle action potentials (CMAPs) in response to direct electrical stimulation of the facial nerve has been shown to improve facial nerve function after surgery for skull base tumours—vestibular schwannoma, in particular 1 – 8. However, triggered CMAP monitoring is not possible when the facial nerve is inaccessible during removal of a large tumour.…”

mentioning

confidence: 99%

Facial nerve motor-evoked potential monitoring during skull base surgery predicts facial nerve outcome

Fukuda¹,

Oishi²,

Takao³

et al. 2008

Journal of Neurology, Neurosurgery & Psychiatry

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“…Recent reports suggest a benefit of proximal to distal CMAP amplitude ratio to predict the postoperative FN outcome (Goldbrunner et al, 2000;Lin et al, 2006). No such specific data exist for the SAN or HN.…”

Section: Cranial Nerve Stimulationmentioning

confidence: 95%

Neurophysiologic Monitoring of the Spinal Accessory Nerve, Hypoglossal Nerve, and the Spinomedullary Region

Skinner¹

2011

Journal of Clinical Neurophysiology

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This review of hypoglossal nerve, spinal accessory nerve, and spinomedullary region intraoperative monitoring details pertinent central and extramedullary anatomy, an updated understanding of proper free-run EMG recording methods and recent developments in stimulation technique and instrumentation. Mapping and monitoring the floor of the fourth ventricle, especially the vagal/hypoglossal trigone region, are emphasized. Although cranial nerve transcranial electrical motor evoked potential recordings can afford appreciation of corticobulbar/corticospinal tract function and secure a more dependable measure of proximate extramedullary somatoefferents, the sometimes difficult implementation and the, as yet, unresolved alert criteria of these recordings demand critical appraisal. Nearby and intimately associated cardiochronotropic and barocontrol neural networks are described; their better understanding is recommended as an important adjunct to "routine" neural monitoring. Finally, an Illustrative case is presented to highlight the many strengths and weaknesses of "state of the art" lower cranial nerve/spinomedullary region monitoring.

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A Novel Method in Predicting Immediate Postoperative Facial Nerve Function Post Acoustic Neuroma Excision

Cited by 20 publications

References 16 publications

Impact of Motor-Evoked Potential Monitoring on Facial Nerve Outcomes after Vestibular Schwannoma Resection

Impact of Motor-Evoked Potential Monitoring on Facial Nerve Outcomes after Vestibular Schwannoma Resection

Facial nerve motor-evoked potential monitoring during skull base surgery predicts facial nerve outcome

Neurophysiologic Monitoring of the Spinal Accessory Nerve, Hypoglossal Nerve, and the Spinomedullary Region

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