Intraoperative transcranial facial motor evoked potential monitoring in surgery of cerebellopontine angle tumors predicts early and late postoperative facial nerve function

Hiruta, Ryo; Sato, Taku; Itakura, Takeshi; Fujii, Masazumi; Sakuma, Jun; Bakhit, Mudathir; Kojima, Takao; Ichikawa, Masahiro; Iwatate, Kensho; Saito, Kiyoshi

doi:10.1016/j.clinph.2020.12.025

Cited by 10 publications

(9 citation statements)

References 22 publications

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“…A FBR <14%, instead, does not allow to draw any pessimistic conclusion on FNF at long-term follow-up, because about 56% of patients eventually experience a FN recovery. Finally, although a recent study 4 reported the potential role of the RV index (a calculated index that derives from subtracting MBR from FBR) in predicting the early and the late FNF, no correlation between this index and both early and late FNF was found in our study.…”

Section: Discussioncontrasting

confidence: 95%

“…[17][18][19][20][21][22][23] In fact, although our study confirms that FBR from OOr is the best predictor of the early FNF, we also proved the best predictor of the late FNF was FBR measured from OOc. From the 4 studies available in the literature investigating the impact of FMEP indexes on the late FNF, 4,[21][22][23] only 2 studies implemented a FMEP registration from both muscles. 20,21 Our data show that a FBR value >14%, as assessed from the OOc, is a guarantee of good FNF at long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…From FMEP amplitudes, we calculated the following indices, as previously reported 4 :Minimum-to-baseline amplitude ratio (MBR): intended as the percentage ratio between the lowest and the baseline FMEP amplitude;Final-to-baseline amplitude ratio (FBR): calculated as the percentage ratio between the final and the baseline FMEP amplitude;Recovery value (RV): calculated as FBR minus MBR.…”

Section: Methodsmentioning

confidence: 99%

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Intraoperative Corticobulbar Motor Evoked Potential in Cerebellopontine Angle Surgery: A Clinically Meaningful Tool to Predict Early and Late Facial Nerve Recovery

et al. 2022

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BACKGROUND:Intraoperative neuromonitoring is crucial for facial nerve preservation in cerebellopontine angle (CPA) surgery. Among the available techniques, the role of intraoperative corticobulbar facial motor evoked potentials (FMEPs) is unclear.OBJECTIVE:To evaluate the significance of intraoperative FMEPs as indicators for early and late postoperative facial nerve function (FNF) in CPA tumor resection and the feasibility of their integration with standard monitoring techniques.METHODS:An institutional series of 83 patients who underwent surgery under intraoperative monitoring for CPA extra-axial tumor resection was reported. A pair of needle electrodes was used to record FMEP from orbicularis oculi (OOc) and orbicularis oris (OOr) muscles at baseline, at the end of surgery and minimum values recorded. From FMEP amplitudes, minimum-to-baseline amplitude ratio (MBR), final-to-baseline amplitude ratio (FBR), and recovery value, intended as FBR minus MBR, were calculated. These indices were correlated with early and late postoperative FNF.RESULTS:Our analysis demonstrated that higher FBR (both from OOc and OOr) and MBR (from OOr only) were associated with a good early and late FNF; a higher MBR from OOc was significantly associated with a good late FNF. The most accurate index in predicting early FNF was FBR measured from OOr with a cutoff of 35.56%, whereas the most accurate index in predicting late FNF was FBR as measured from OOc with a cutoff of 14.29%.CONCLUSION:Our study confirmed that FMEPs are reliable predictors of early and late postoperative FNF in CPA surgery and could be easily integrated with standard intraoperative neuromonitoring techniques.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Intraoperative Corticobulbar Motor Evoked Potential in Cerebellopontine Angle Surgery: A Clinically Meaningful Tool to Predict Early and Late Facial Nerve Recovery

et al. 2022

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“…Intraoperative facial nerve monitoring is considered as a gold standard in VS surgery to preserve facial integrity [ 39 ]. The occurrence of A-trains is regarded as a warning criterion in fEMG monitoring (i.e., train-time criterion) [ 29 , 30 ], while a reduction in amplitude of more than 40–50% is assessed as critical in FNMEP (i.e., final-to-baseline ratio, FBR) [ 5 , 7 , 8 , 14 , 41 ]. However, quantitative analysis of pathological A-trains with differentiation to other EMG patterns during surgery is difficult [ 29 , 30 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive value of facial motor–evoked potential and electromyography for facial motor function in vestibular schwannoma surgery

Machetanz,

Roegele,

Liebsch

et al. 2024

Acta Neurochir

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Purpose Intraoperative neuromonitoring (IONM) aims to preserve facial nerve (FN) function during vestibular schwannoma (VS) surgery. However, current techniques such as facial nerve motor evoked potentials (FNMEP) or electromyography (fEMG) alone are limited in predicting postoperative facial palsy (FP). The objective of this study was to analyze a compound fEMG/FNMEP approach. Methods Intraoperative FNMEP amplitude and the occurrence of fEMG-based A-trains were prospectively determined for the orbicularis oris (ORI) and oculi (OCU) muscle in 322 VS patients. Sensitivity and specificity of techniques to predict postoperative FN function were calculated. Confounding factors as tumor size, volume of intracranial air, or IONM duration were analyzed. Results A relevant immediate postoperative FP was captured in 105/322 patients with a significant higher risk in large VS. While fEMG demonstrated a high sensitivity (77% and 86% immediately and 15 month postoperative, respectively) for identifying relevant FP, specificity was low. In contrast, FNMEP have a significantly higher specificity of 80.8% for predicting postoperative FP, whereas the sensitivity is low. A retrospective combination of techniques demonstrated still an incorrect prediction of FP in ~ 1/3 of patients. Conclusions FNMEP and fEMG differ in sensitivity and specificity to predict postoperative FP. Although a combination of IONM techniques during VS surgery may improve prediction of FN function, current techniques are still inaccurate. Further development is necessary to improve IONM approaches for FP prediction.

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“…According to current research, 28%-67.1% of patients with acoustic neuroma have an unsatisfied (House-Brackman grade Ⅲ-Ⅵ) short-term (within two weeks after surgery) facial nerve function prognosis [11][12][13] . Many scholars have analyzed relevant risk factors.…”

mentioning

confidence: 98%

Development and Validation of a Deep Learning Predictive Model Combining Clinical and Radiomic Features for Short-Term Postoperative Facial Nerve Function in Acoustic Neuroma Patients

Wang

Jia

et al. 2023

CURR MED SCI

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Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging (MRI) for short-term postoperative facial nerve function in patients with acoustic neuroma. Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included. Clinical data and raw features from four MRI sequences (T1-weighted, T2-weighted, T1-weighted contrast enhancement, and T2-weighted-Flair images) were analyzed. Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features. Nomogram, machine learning, and convolutional neural network (CNN) models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate model performance. A total of 1050 radiomic parameters were extracted, from which 13 radiomic and 3 clinical features were selected. Results The CNN model performed best among all prediction models in the test set with an area under the curve (AUC) of 0.89 (95% CI, 0.84–0.91). Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma. As such, CNN modeling may serve as a potential decision-making tool for neurosurgery.

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Intraoperative transcranial facial motor evoked potential monitoring in surgery of cerebellopontine angle tumors predicts early and late postoperative facial nerve function

Cited by 10 publications

References 22 publications

Intraoperative Corticobulbar Motor Evoked Potential in Cerebellopontine Angle Surgery: A Clinically Meaningful Tool to Predict Early and Late Facial Nerve Recovery

Intraoperative Corticobulbar Motor Evoked Potential in Cerebellopontine Angle Surgery: A Clinically Meaningful Tool to Predict Early and Late Facial Nerve Recovery

Predictive value of facial motor–evoked potential and electromyography for facial motor function in vestibular schwannoma surgery

Development and Validation of a Deep Learning Predictive Model Combining Clinical and Radiomic Features for Short-Term Postoperative Facial Nerve Function in Acoustic Neuroma Patients

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