Intraoperative electrical stimulation for identification of cranial nerve nuclei

Chang, Steven D.; López, Jaime; Steinberg, Gary K.

doi:10.1002/(sici)1097-4598(199911)22:11<1538::aid-mus8>3.0.co;2-0

Cited by 22 publications

(5 citation statements)

References 24 publications

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“…IONM helps the assessment of the integrity of the neural structures during surgical procedures. Since the first work of the group of Chang (Chang et al, 1999) to the study carried out on the huge sample of 100 patients made by Fernández-Conejero (Fernández-Conejero et al, 2022), the use of Cb-MEPs has become increasingly essential in monitoring the functioning of facial nerve during skull base surgery and/or in the brainstem surgery (Zhou and Kelly, 2001; Fukuda et al, 2008). To date, a general agreement of the usefulness of Cb-MEPs has been achieved, considering that it is able to determine the facial nerve outcome with a good accuracy (Akagami et al, 2005, Dong et al, 2005, Fukuda et al, 2008; Morota et al, 2010), despite some limitations due to the challenging interpretation if a response arises from peripheral or central stimulation (Tellez et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…IntraOperative NeuroMonitoring (IONM) of cranial nerves, especially of the facial nerve (Chang et al, 1999), is important to spare their functioning and to reduce the incidence of new neurological deficit in several neurosurgical procedures, above all in brainstem and skull base surgery (Isackson et al, 2005; Morota et al, 2010; Kodama et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

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Three montages for Transcranial Electric Stimulation in predicting the early post-surgery outcome of the facial nerve functioning

Izzo,

Sebastiano,

Catanzaro

et al. 2024

Preprint

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Objective: We assessed the Transcranial Electrical Stimulation (TES)-induced Corticobulbar-Motor Evoked Potentials (Cb-MEPs) evoked from Orbicularis Oculi (Oc) and Orbicularis Oris (Or) muscles with FCC5h/FCC6h-Mz, C3/C4-Cz and C5/C6/-Cz stimulation, during IntraOperative NeuroMonitoring (IONM) in 30 patients who underwent skull-base surgery. Methods: before (T0) and after (T1) the surgery, we compared the peak-to-peak amplitudes of Cb-MEPs obtained from TES with C3/C4-Cz, C5/C6-Cz and FCC5h/FCC6h-Mz. Then, we compared the response category (present, absent and peripheral) related to different montages. Finally, we classified the Cb-MEPs data from each patient for concordance with clinical outcome and we assessed the diagnostic measures for Cb-MEPs data obtained from FCC5h/FCC6h-Mz, C3/C4-Cz and C5/C6-Cz TES stimulation. Results: Both at T0 and T1, FCC5h/FCC6h-Mz stimulation evoked larger Cb-MEPs than C3/C4-Cz, less peripheral responses from direct activation of facial nerve than C5/C6-Cz. FCC5h/FCC6h-Mz stimulation showed the best accuracy and specificity of Cb-MEPs for clinical outcomes. Conclusions: FCC5h/FCC6h-Mz stimulation showed the best performances for monitoring the facial nerve functioning, maintaining excellent diagnostic measures even at low stimulus voltages. Significance: We demonstrated that FCC5h/FCC6h-Mz TES montage for Cb-MEPs in IONM has good accuracy in predicting the post-surgery outcome of facial nerve functioning.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Three montages for Transcranial Electric Stimulation in predicting the early post-surgery outcome of the facial nerve functioning

Izzo,

Sebastiano,

Catanzaro

et al. 2024

Preprint

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“…Absence of response from single-pulse stimulation and presence of response from multi-pulse stimulation indicate that the response transmits via the corticobulbar tract rather than direct current spread [ 13 ]. In addition, cranial nuclei, especially facial colliculus, can be also mapped in the brainstem during surgery by direct stimulation [ 6 , 17 , 43 , 69 ]. Diligent application of IOM in brainstem surgery can reduce, or at least weigh in advance, the risk of serious functional deficits such as dysphasia, dysphonia, facial palsy, or hearing loss.…”

Section: Principles and Techniquesmentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring : A Review of Techniques Used for Brain Tumor Surgery in Children

Kim

Cho

Bang

et al. 2018

J Korean Neurosurg Soc

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Intraoperative monitoring (IOM) utilizes electrophysiological techniques as a surrogate test and evaluation of nervous function while a patient is under general anesthesia. They are increasingly used for procedures, both surgical and endovascular, to avoid injury during an operation, examine neurological tissue to guide the surgery, or to test electrophysiological function to allow for more complete resection or corrections. The application of IOM during pediatric brain tumor resections encompasses a unique set of technical issues. First, obtaining stable and reliable responses in children of different ages requires detailed understanding of normal ageadjusted brain-spine development. Neurophysiology, anatomy, and anthropometry of children are different from those of adults. Second, monitoring of the brain may include risk to eloquent functions and cranial nerve functions that are difficult with the usual neurophysiological techniques. Third, interpretation of signal change requires unique sets of normative values specific for children of that age. Fourth, tumor resection involves multiple considerations including defining tumor type, size, location, pathophysiology that might require maximal removal of lesion or minimal intervention. IOM techniques can be divided into monitoring and mapping. Mapping involves identification of specific neural structures to avoid or minimize injury. Monitoring is continuous acquisition of neural signals to determine the integrity of the full longitudinal path of the neural system of interest. Motor evoked potentials and somatosensory evoked potentials are representative methodologies for monitoring. Free-running electromyography is also used to monitor irritation or damage to the motor nerves in the lower motor neuron level : cranial nerves, roots, and peripheral nerves. For the surgery of infratentorial tumors, in addition to free-running electromyography of the bulbar muscles, brainstem auditory evoked potentials or corticobulbar motor evoked potentials could be combined to prevent injury of the cranial nerves or nucleus. IOM for cerebral tumors can adopt direct cortical stimulation or direct subcortical stimulation to map the corticospinal pathways in the vicinity of lesion. IOM is a diagnostic as well as interventional tool for neurosurgery. To prove clinical evidence of it is not simple. Randomized controlled prospective studies may not be possible due to ethical reasons. However, prospective longitudinal studies confirming prognostic value of IOM are available. Furthermore, oncological outcome has also been shown to be superior in some brain tumors, with IOM. New methodologies of IOM are being developed and clinically applied. This review establishes a composite view of techniques used today, noting differences between adult and pediatric monitoring.

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“…12,20,39,40 As previously mentioned, oculomotor monitoring can be used to identify the location and extent of relevant structures. Here, the electrically evoked activity of the abducens nucleus can be tested using recording electrodes in the lateral rectus muscles.…”

Section: Metencephalic Lesionsmentioning

confidence: 99%

Operative management of brainstem cavernous malformations

Asaad

Walcott²,

Nahed³

et al. 2010

FOC

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Brainstem cavernous malformations (CMs) are complex lesions associated with hemorrhage and neurological deficit. In this review, the authors describe the anatomical nuances relating to the operative techniques for these challenging lesions. The resection of brainstem CMs in properly selected patients has been demonstrated to reduce the risk of rehemorrhage and can be achieved relatively safely in experienced hands.

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Intraoperative electrical stimulation for identification of cranial nerve nuclei

Cited by 22 publications

References 24 publications

Three montages for Transcranial Electric Stimulation in predicting the early post-surgery outcome of the facial nerve functioning

Three montages for Transcranial Electric Stimulation in predicting the early post-surgery outcome of the facial nerve functioning

Intraoperative Neurophysiological Monitoring : A Review of Techniques Used for Brain Tumor Surgery in Children

Operative management of brainstem cavernous malformations

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