Intraoperative monitoring of sensory part of the trigeminal nerve using blink reflex during microvascular decompression for trigeminal neuralgia

Simioni, Valentina; Capone, J.G.; Sette, Elisabetta; Granieri, Enrico; Farneti, Marco; Cavallo, Michele Alessandro; Tugnoli, V.

doi:10.1007/s00701-017-3405-8

Cited by 15 publications

(6 citation statements)

References 24 publications

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“…Deletis et al 13 used a short-train technique and successfully recorded the BR's R1 component, an oligosynaptic pontine reflex. On the other hand, the R2 component is still considered as nonrecordable, [13][14][15] which matches our observation. The reason for this finding might be that it takes a longer distance and consists of polysynaptic connections of trigeminal fibers, which are easily suppressed by anesthetic drugs than an oligosynaptic pathway.…”

Section: Discussionsupporting

confidence: 87%

“…Since then, few other studies have recorded the use of this method in the operating theatre. 14,15 The aim of the present study was to test the utility of BR for intraoperative monitoring of facial nerve integrity, assess its prognostic value for facial nerve functions, and compare it with that of facial CoMEPs. To the best of our knowledge, this is the first case series evaluating and establishing the statistical validity of the BR as an intraoperative neuromonitoring method for assessing facial nerve integrity in surgeries of lesions residing near the brainstem.…”

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confidence: 99%

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Intraoperative Neuromonitoring of Blink Reflex During Posterior Fossa Surgeries and Its Correlation With Clinical Outcome

Aydınlar

Koçak

Soykam

et al. 2020

Journal of Clinical Neurophysiology

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Purpose:Blink reflex (BR) under general anesthesia as an intraoperative neuromonitoring method was used to monitor facial nerves in few studies. This study aimed to test the utility of intraoperative BR during cerebellopontine angle and skull base surgeries, assess its prognostic value for facial nerve functions, and compare it with facial corticobulbar motor evoked potentials (CoMEPs).Methods:Blink reflex and facial CoMEPs were recorded from 40 patients undergoing skull base surgeries. Subdermal needles were placed in the supraorbital notch for stimulation and in the orbicularis oculi muscle for recording the BR. A double train of 20 to 40 V intensity with an intertrain interval of 40 to 60 milliseconds, an interstimulus interval of 2.5 milliseconds, and a stimulus duration of 0.5 milliseconds were applied. Facial nerve functions were assessed with the House–Brackmann grading system in the postoperative day 1 and third-month period and correlated with intraoperative BR and CoMEPs measurements.Results:Of 40 patients, BR was recordable on the affected side in 32 (80%) and contralateral side in 35 (87.5%) patients. According to our statistical results, BR had a slightly better sensitivity than facial CoMEPs in predicting impairment of facial nerve functions for both postoperative and third-month time points. Blink reflex showed better accuracy for predicting postoperative nerve functions, whereas CoMEPs correlated better in predicting third-month outcome.Conclusions:We suggest that BR is a valuable intraoperative neuromonitoring method that can be used in addition to facial CoMEPs during skull base surgeries to assess real-time facial nerve integrity and predict prognosis.

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

Intraoperative Neuromonitoring of Blink Reflex During Posterior Fossa Surgeries and Its Correlation With Clinical Outcome

Aydınlar

Koçak

Soykam

et al. 2020

Journal of Clinical Neurophysiology

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“…This intraoperative BR recording method has been used in several studies to monitor trigeminal or facial nerve function during MVD and posterior fossa surgeries. [47][48][49] In this study, we found that the absence of R1 post was significantly associated with complete pain relief and facial numbness following PBC. Therefore, we consider that intraoperative monitoring of BR would be feasible during PBC, and that the absence of R1 may provide real-time feedback on the surgical effect and provide a reference point for terminating the compression.…”

Section: Discussionmentioning

confidence: 52%

Blink reflex: A practical test to evaluate the trigeminal nerve injury following percutaneous balloon compression for the treatment of trigeminal neuralgia

Tian

Zhou

et al. 2022

Headache

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Objective: To evaluate the blink reflex (BR) in estimating the potential injury of trigeminal nerve following percutaneous balloon compression (PBC) surgery, and to determine the association between BR alterations and early surgical outcomes. Methods:In this single-center, prospective before-and-after study, a total of 74 patients who had primary trigeminal neuralgia and scheduled for PBC between October 2020 and June 2021 were prospectively included. BR testing and facial sensory assessment were performed pre-and post-PBC. The latency and the area under the curve (AUC) of pre-and postoperative R1 (R1 pre /R1 post ) and R2 (R2 pre /R2 post ) were measured. Results:The BR components were noticeably delayed or diminished following PBC.R1 post was elicited in only 26 patients, and absent in 48 patients. The residual R1 post had markedly reduced AUC (median difference [Hodges-Lehmann]: −59.5, 95% confidence interval [CI]: −217.5 to −6.9, p = 0.023). Compared with R2 pre , the latency of R2 post was considerably delayed (mean difference: 4.3, 95% CI: 2.9 to 5.7, p < 0.001) and the AUC was greatly suppressed (median difference [Hodges-Lehmann]: −388.4, 95% CI: −548.4 to −259.5, p < 0.001). After PBC, 58 patients had immediate total pain relief, and 16 had partial relief. The absence of R1 post was found in 46 of 58 (79.3%) patients with complete remission, whereas in only 2 of 16 (12.5%) patients with partial relief. Association analysis showed that the absence of R1 post was strongly associated with total pain relief (46/58 [79.3%] vs. 2/16 [12.5%], odds ratio [OR]: 26.8, 95% CI: 5.4 to 134.5, Cramér's V: 0.6, p < 0.001). The latency of R2 post in patients with total relief was significantly delayed (mean difference: 2.5, 95% CI: 0.3 to 4.6, p = 0.028).Patients experienced graded facial numbness after PBC, of whom 31 reported mild numbness (Grades I-II) and 43 reported more severe numbness (Grades III-IV). The absence of R1 post was significantly associated with facial numbness severity, 33/43

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“…It can stimulate the skin of the trigeminal nerve distribution area through a specially designed concentric electrode, which can excite the pain nerve fibers of the corresponding area alone to objectively judge the function and abnormality of the trigeminal pain conduction pathway [25]. Blink reflex (BR) is a critical electrophysiological method to detect trigeminal and facial nerve injury [26]. In addition, BR, including early response R 1 on the stimulation side and late response R 2 and R 2 on both sides, is a critical electrophysiological index reflecting brainstem function, which is widely used in the clinical evaluation of brainstem function [27].…”

Section: Discussionmentioning

confidence: 99%

The diagnostic value of pain evoked potential by electrical stimulation combined with noceciptive blink reflex in trigeminal neuralgia

Ren¹,

Han²,

Lu³

et al. 2021

Journal of Integrative Neuroscience

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Microvascular decompression is the first choice for treating the primary trigeminal neuralgia to provide the most extended duration of pain freedom. However, in microvascular decompression, we found that this kind of operation is only suitable for some patients. It is of great value to objectively judge the function and abnormality of the trigeminal pain conduction pathway in guiding the operation process. This brief report investigates the value of pain evoked potential by electrical stimulation and noceciptive blink reflex in trigeminal neuralgia. We detected the pain evoked potential in 34 patients with trigeminal neuralgia and 48 healthy controls treated by electrical stimulation and blink reflex. We demonstrated no significant differences in the latencies of V1, V2, V3, and R2 of the affected side and the contralateral side in patients with trigeminal neuralgia. The latencies of those four indicators of the affected side in patients with trigeminal neuralgia were notably decreased compared to those on the same side in healthy controls. The receiver operating characteristic curve analysis showed that the area under curve, sensitivity and specificity of the combined diagnosis of latency and amplitude were significantly higher than the single diagnosis. The latency and amplitude of V1 were highly sensitive, while those of V2 was highly specific. Trigeminal neuralgia can be effectively diagnosed by combining pain evoked potential by electrical stimulation and noceciptive blink reflex. The pathogenesis of trigeminal neuralgia should be combined with peripheral pathogenicity and the theory of central pathogenicity.

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Intraoperative monitoring of sensory part of the trigeminal nerve using blink reflex during microvascular decompression for trigeminal neuralgia

Cited by 15 publications

References 24 publications

Intraoperative Neuromonitoring of Blink Reflex During Posterior Fossa Surgeries and Its Correlation With Clinical Outcome

Intraoperative Neuromonitoring of Blink Reflex During Posterior Fossa Surgeries and Its Correlation With Clinical Outcome

Blink reflex: A practical test to evaluate the trigeminal nerve injury following percutaneous balloon compression for the treatment of trigeminal neuralgia

The diagnostic value of pain evoked potential by electrical stimulation combined with noceciptive blink reflex in trigeminal neuralgia

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