Effectiveness of C5 or C6-Cz assembly in predicting immediate post operative facial nerve deficit

Verst, Silvia Mazzali; Sucena, Andrea Caivano; Maldaun, Marcos Vinícius Calfat; Aguiar, Paulo Henrique Pires de

doi:10.1007/s00701-013-1806-x

Cited by 11 publications

(8 citation statements)

References 28 publications

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“…8 Whereas Bhimrao et al found that an FMEP ratio of approximately 0.6 yielded favorable prognostic value, numerous published reports have used a cutoff FMEP ratio of 0.5 and found similarly high predictive values. 5,30-32 In our cohort, a FMEP ratio of 0.5 was associated with PPV 71.4% at long-term follow-up. These discrepant results may be due to the comparatively small sample size of the present study.…”

Section: Discussionmentioning

confidence: 50%

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: 50%

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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“…Special attention should be for SSEPs during bleeding or vascular traction, also, anatomical features of the area surgery, dorsal or ventral brain stem surface, as described in Xuesong Liu and al [24]. The experience described in the numerous articles demonstrates the effectiveness of CoMEPs use to achieve on-line monitoring of control to functional integrity cranial motors fibers [18,[25][26][27][28][29][30], if followed at the all rules, the registration can be without interruption the surgeon's work [16,27]. In recent years, the use of different types of reflexes became frequently [27,[31][32][33][34], oppositely BAEPs technique which was basic in the 90s for brainstem monitoring [35,36], but in our time gives only 20% of the brainstem area [10,26].…”

Section: Discussionmentioning

confidence: 99%

Continuous Dynamic Mapping of Cranial Nerve Pathways and Long Tracts Inside the Brainstem: Useful Technique of Intraoperative Neurophysiological Monitoring

Smolanka

Smolanka²,

Sechko³

et al. 2021

International Journal of Biology and Biomedical Engineering

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Surgery of intrinsic brainstem lesions is extremely dangerous, consequently the knowledge of anatomy and safe entry zones is extremely important. The technological progress was achieved with the widespread clinical use of intraoperative neurophysiological monitoring (IONM) which has proven to further improve the safety of operating on intrinsic brainstem lesions. The relevance of the study is conditioned by the fact that the tumor alters the normal anatomy and distorts the location of well-known landmarks and structures. In this regard, this paper is directed at identification of the placement of conductive pathways in the thickness of the brain stem and directly in the depth of the lesion (in the tumor or cavern), respectively to the surgical manipulations aimed at injury prevention. The results were achieved by a retrospective review of medical reports. The paper represents the results of surgical treatment of 42 patients with brainstem lesions, reviews the localization of the lesion and neurological status of patients, describes available methods of intraoperative monitoring (IOM) and on-line techniques for the brainstem surgery. The materials of the paper are of practical significance for the development of brainstem surgery with IONM modifications for wider and more comfortable use by neurosurgeons.

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“…The location of anodes was therefore approximately similar to that of the anodes already reported for MEPs of the facial nerve. 23 Stimulation made of a single pulse was applied from time to time to verify that the stimulation did not directly excite the facial nerve distally. 24 The MEPs were measured using subdermal needles (DSN2282, Medtronic Xomed Inc., Jacksonville, Florida, United States) positioned in different muscles of the lower hemiface (mentalis or orbicularis oris, nasalis) ipsilateral to the side of the surgery.…”

Section: Monitoringmentioning

confidence: 99%

Sensitivity and Negative Predictive Value of Motor Evoked Potentials of the Facial Nerve

Bovo

Momjian

Gondar³

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Objective The objective of this study was to determine the performance of the standard alarm criterion of motor evoked potentials (MEPs) of the facial nerve in surgeries performed for resections of vestibular schwannomas or of other lesions of the cerebellopontine angle. Methods This retrospective study included 33 patients (16 with vestibular schwannomas and 17 with other lesions) who underwent the resection surgery with transcranial MEPs of the facial nerve. A reproducible 50% decrease in MEP amplitude, resistant to a 10% increase in stimulation intensity, was applied as the alarm criterion during surgery. Facial muscular function was clinically evaluated with the House–Brackmann score (HBS), pre- and postsurgery at 3 months. Results In the patient group with vestibular schwannoma, postoperatively, the highest sensitivity and negative predictive values were found for a 30% decrease in MEP amplitude, that is, a criterion stricter than the 50% decrease in MEP amplitude criterion, prone to trigger more warnings, used intraoperatively. With this new criterion, the sensitivity would be 88.9% and the negative predictive value would be 85.7%. In the patient group with other lesions of the cerebellopontine angle, the highest sensitivity and negative predictive values were found equally for 50, 60, or 70% decrease in MEP amplitude. With these criteria, the sensitivities and the negative predictive values would be 100.0%. Conclusion Different alarm criteria were found for surgeries for vestibular schwannomas and for other lesions of the cerebellopontine angle. The study consolidates the stricter alarm criterion, that is, a criterion prone to trigger early warnings, as found previously by others for vestibular schwannoma surgeries (30% decrease in MEP amplitude).

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Effectiveness of C5 or C6-Cz assembly in predicting immediate post operative facial nerve deficit

Abstract: In this series, the used montage was effective in predicting new facial deficit.

Cited by 11 publications

References 28 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

Continuous Dynamic Mapping of Cranial Nerve Pathways and Long Tracts Inside the Brainstem: Useful Technique of Intraoperative Neurophysiological Monitoring

Sensitivity and Negative Predictive Value of Motor Evoked Potentials of the Facial Nerve

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