CE-Chirp® ABR in cerebellopontine angle surgery neuromonitoring: technical assessment in four cases

Scipio, Ettore Di; Mastronardi, Luciano

doi:10.1007/s10143-015-0609-3

Cited by 19 publications

(7 citation statements)

References 4 publications

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“…Results of hearing preservation in AN surgery have also improved over the past decades, especially in treatment of smaller tumors. In our series, the recent use of intraoperative ABRs with CE-Chirp stimulus 26 improved intraoperative monitoring of hearing, with quick brain stem evoked responses after stimuli. For attempting hearing preservation, we selected patients belonging to classes A and B of the AAO-HNS classification.…”

Section: Discussionmentioning

confidence: 88%

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How I Do It: The Role of Flexible Hand-held 2μ-Thulium Laser Fiber in Microsurgical Removal of Acoustic Neuromas

et al. 2017

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We performed a retrospective nonrandomized study to analyze the results of microsurgery of acoustic neuromas (AN) using 2μ-thulium flexible hand-held laser fiber (Revolix jr). From September 2010 to September 2015, 89 patients suffering from AN have been operated on with microsurgical technique via retrosigmoid approach. In 37 cases, tumor resection was performed with the assistance of 2μ-thulium flexible hand-held laser fiber (L-group). Eight cases operated on with the assistance of CO hand-held flexible laser fiber were excluded from this study. A total of 44 patients, operated on without laser assistance during the same period, were used as comparison group (C-group) (matched pair technique). Facial nerve function was assessed with the House-Brackmann (HB) scale preoperatively, and 1 week and 6 months postoperatively. Overall time from incision to skin suture changed in relation to size of tumor (165-575 minutes) and was not affected by the use of laser. In 7 out of 81 cases, a preoperative facial nerve palsy HB2 and in 1 case, HB4 (permanent) were observed. In the remaining 80 cases, at 6-month follow-up, facial nerve preservation rate (HB1) was 92.5%. Hearing preservation rate (AAO-HNS A/B classes) was 68.2% (26 out of 36). Adopting a 0 to 3 scale, the mean surgeon satisfaction rate of usefulness of laser fiber was 2.7. The use of 2μ-thulium hand-held flexible laser fiber in AN microsurgery seems to be safe and subjectively facilitates tumor resection especially in "difficult" conditions (e.g., highly vascularized and hard tumors). In this limited retrospective trial, the good functional outcome following conventional microsurgery had not further improved, nor the surgical time reduced by laser. Focusing its use on "difficult" (large and vascularized) cases may lead to different results in future.

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Section: Discussionmentioning

confidence: 88%

“…In the last 12 cases, we used ABR neuromonitoring evoked with CE-Chirp stimuli (Interacoustics Eclipse EP15 ABR system). 26 In both L-and C-groups, there were 36 patients AAO-HNS class A or B, with reproducible responses that allowed a continuous intraoperative ABR monitoring of cochlear nerve.…”

Section: Monitoring Of Facial and Cochlear Nervesmentioning

confidence: 99%

How I Do It: The Role of Flexible Hand-held 2μ-Thulium Laser Fiber in Microsurgical Removal of Acoustic Neuromas

et al. 2017

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“…[6,7,27,37,[46][47][48][49]. Using the intraoperative monitoring with quick brainstem evoked responses and CE-Chirp stimulus effect on the results of hearing preservation [50]. Of course we selected only patients belonging to classes A and B of the AAO-HNS classification pre-operatively for determining the rate of hearing preservation considering that this kind of selection makes selection bias in the results.…”

Section: Discussionmentioning

confidence: 99%

Vestibular Schwannomas Microsurgery Assisted by Flexible Hand-Held 2 micro-Thulium-Fiber Laser

Mastronardi

Cacciotti

Roperto

et al. 2016

Caspian.J.Neurol.Sci

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Background: Vestibular Schwannoma (VS) is one of the skull base tumors originating from vestibular portion of eighth cranial nerve. Recently, 2 microThulium laser is used in the surgery of some intracranial tumors. Objectives: Assessing the efficacy of 2 micro-Thulium flexible hand-held laser fiber (Revolixjr ® ) in microsurgical removal of VS. Materials and Methods:This retrospective non-randomized study was carried out from July 2012 to November 2015. 39 patients with VS had been operated on with microsurgical technique via retro-sigmoid approach. 2 micro-Thuliumfiber hand-held flexible laser was used for tumor resection in 39 cases. Facial nerves function by House-Brackmann (HB) scale and hearing state were assessed preoperatively and 1 week and 6-month postoperatively. Results: Overall time of surgery changed only in proportion with the size of tumor (185-575 minutes) and was not affected by the use of laser. In 5out of 39cases, preoperative facial nerve palsy HB2, and in one case HB4 (permanent) was observed. On considering 38 cases, at 6-month follow-up facial nerve preservation rate (HB1) was 92.1% (from May 2015 all patients had not postoperative facial palsy). Hearing preservation rate was possible in 12 out of 15 cases with previously acceptable preoperative hearing state (AAO-HNS A and B classes). The mean surgeon satisfaction rate of usefulness of this technic was 2.7 in a 0-3-scale Conclusions: A good functional outcome including facial nerve preservation and hearing preservation was obtained by micro-Thulium-fiber hand-held flexible laser microsurgery.

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“…In all cases, brainstem auditory evoked response (BAER) with LS-CE-Chirp (Interacoustics Eclipse-EP15-ABR-System, Copenhagen, Denmark) stimulus was performed to provide intraoperative control hearing function. 14 The retrosigmoid craniectomy was $ 2.5 cm 2 , with exposure of the sigmoid and transverse sinuses. The dura mater was opened, and cerebrospinal fluid (CSF) was slowly released from the arachnoid cisterns to obtain cerebellar hemisphere decompression.…”

Section: Operative Techniquementioning

confidence: 99%

Typical Trigeminal Neuralgia: Comparison of Results between Patients Older and Younger than 65 Years Operated on with Microvascular Decompression by Retrosigmoid Approach

Mastronardi

Caputi

Rinaldi

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Objective The incidence of typical trigeminal neuralgia (TN) increases with age, and neurologists and neurosurgeons frequently observe patients with this disorder at age 65 years or older. Microvascular decompression (MVD) of the trigeminal root entry zone in the posterior cranial fossa represents the etiological treatment of typical TN with the highest efficacy and durability of all treatments. This procedure is associated with possible risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the alternative ablative procedures. Thus the safety of MVD in the elderly remains a topic of discussion. This study was conducted to determine whether MVD is a safe and effective treatment in older patients with TN compared with younger patients. Methods In this retrospective study, 28 patients older than 65 years (elderly cohort: mean age 70.9 ± 3.6 years) and 38 patients < 65 years (younger cohort: mean age 51.7 ± 6.3 years) underwent MVD via the keyhole retrosigmoid approach for type 1 TN (typical) or type 2a TN (typically chronic) from November 2011 to November 2017. A 75-year-old patient and three nonelderly patients with type 2b TN (atypical) were excluded. Elderly and younger cohorts were compared for outcome and complications. Results At a mean follow-up 26.0 ± 5.5 months, 25 patients of the elderly cohort (89.3%) reported a good outcome without the need for any medication for pain versus 34 (89.5%) of the younger cohort. Twenty-three elderly patients with type 1 TN were compared with 30 younger patients with type 1 TN, and no significant difference in outcomes was found (p > 0.05). Five elderly patients with type 2a TN were compared with eight younger patients with type 2a TN, and no significant difference in outcomes was noted (p > 0.05). There was one case of cerebrospinal fluid leak and one of a cerebellar hematoma, both in the younger cohort. Mortality was zero in both cohorts. Conclusions On the basis of our experience and the international literature, age itself does not seem to represent a major contraindication of MVD for TN.

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CE-Chirp® ABR in cerebellopontine angle surgery neuromonitoring: technical assessment in four cases

Cited by 19 publications

References 4 publications

How I Do It: The Role of Flexible Hand-held 2μ-Thulium Laser Fiber in Microsurgical Removal of Acoustic Neuromas

How I Do It: The Role of Flexible Hand-held 2μ-Thulium Laser Fiber in Microsurgical Removal of Acoustic Neuromas

Vestibular Schwannomas Microsurgery Assisted by Flexible Hand-Held 2 micro-Thulium-Fiber Laser

Typical Trigeminal Neuralgia: Comparison of Results between Patients Older and Younger than 65 Years Operated on with Microvascular Decompression by Retrosigmoid Approach

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