The prognostic value of intraoperative BAEP patterns in acoustic neurinoma surgery

Neu, Mandana; Strauß, Christian; Romstöck, J.; Bischoff, Barbara; Fahlbusch, Rudolf

doi:10.1016/s1388-2457(99)00148-0

Cited by 63 publications

(38 citation statements)

References 21 publications

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“…The auditory brainstem response (ABR) remains the most widely and successfully used auditory evoked potential in clinical practice [Jewett and Williston, 1971;Jacobson, 1985;Hall, 1992;Delgado and Ozdamar, 1994;Neu et al, 1999;Battista et al, 2000;Sininger et al, 2001]. Part of this success stems from the relative ease in which the ABR is analysed, that is, most clinicians simply identify the peaks of interest (primarily peaks I, III and V) and then compare their latencies, and occasionally their amplitudes, to matched normative data.…”

Section: Introductionmentioning

confidence: 99%

Automated Analysis of the Auditory Brainstem Response Using Derivative Estimation Wavelets

Bradley¹,

Wilson

2004

Audiol Neurotol

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In this paper, we describe an algorithm that automatically detects and labels peaks I–VII of the normal, suprathreshold auditory brainstem response (ABR). The algorithm proceeds in three stages, with the option of a fourth: (1) all candidate peaks and troughs in the ABR waveform are identified using zero crossings of the first derivative, (2) peaks I–VII are identified from these candidate peaks based on their latency and morphology, (3) if required, peaks II and IV are identified as points of inflection using zero crossings of the second derivative and (4) interpeak troughs are identified before peak latencies and amplitudes are measured. The performance of the algorithm was estimated on a set of 240 normal ABR waveforms recorded using a stimulus intensity of 90 dBnHL. When compared to an expert audiologist, the algorithm correctly identified the major ABR peaks (I, III and V) in 96–98% of the waveforms and the minor ABR peaks (II, IV, VI and VII) in 45–83% of waveforms. Whilst peak II was correctly identified in only 83% and peak IV in 77% of waveforms, it was shown that 5% of the peak II identifications and 31% of the peak IV identifications came as a direct result of allowing these peaks to be found as points of inflection.

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Section: Introductionmentioning

confidence: 99%

Automated Analysis of the Auditory Brainstem Response Using Derivative Estimation Wavelets

Bradley¹,

Wilson

2004

Audiol Neurotol

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“…Conventional BAEP monitoring takes a small amount of time to detect waveform changes (wave-V loss), which is based on averaging of 500-2000 electrical signals, [10][11][12]16,21,24 whereas continuous direct AEDNAP monitoring can recognize immediate risk for nerve damage. Our present method of continuous direct FREMAP monitoring uses our specially developed FREMAP electrode, in contrast to the semispherical, freely mobile electrode previously used to stimulate the cisternal portion of the facial nerve.…”

Section: Discussionmentioning

confidence: 99%

“…8,14,15,20,28 Therefore, novel methods (continuous direct neurophysiological monitoring) have been introduced to achieve immediate intraoperative feedback and successful prognostic assessment. 2,6,[10][11][12]16,17,21,25 Two methods that have the potential to Improved preservation of function during acoustic neuroma surgery warn neurosurgeons of neural damage directly caused by surgical procedures are continuous direct auditory evoked dorsal cochlear nucleus action potential (AEDNAP) monitoring and facial nerve root exit zone-elicited compound muscle action potential (FREMAP) monitoring. Fortunately, gradual reversal of cochlear nerve injury after surgical procedures has been confirmed in humans 25,26 and animals.…”

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confidence: 99%

Improved preservation of function during acoustic neuroma surgery

Nakatomi

Miyazaki

Tanaka

et al. 2015

JNS

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OBJect Restoration of cranial nerve functions during acoustic neuroma (AN) surgery is crucial for good outcome. The effects of minimizing the injury period and maximizing the recuperation period were investigated in 89 patients who consecutively underwent retrosigmoid unilateral AN surgery. MetHODS Cochlear nerve and facial nerve functions were evaluated during AN surgery by use of continuous auditory evoked dorsal cochlear nucleus action potential monitoring and facial nerve root exit zone-elicited compound muscle action potential monitoring, respectively. Factors affecting preservation of function at the same (preoperative) grade were analyzed. reSUltS A total of 23 patients underwent standard treatment and investigation of the monitoring threshold for preservation of function; another 66 patients underwent extended recuperation treatment and assessment of its effect on recovery of nerve function. Both types of final action potential monitoring response and extended recuperation treatment were associated with preservation of function at the same grade. cOnclUSiOnS Preservation of function was significantly better for patients who received extended recuperation treatment.http://thejns.org/doi/abs/10.3171/2014.8.JNS132525KeY WOrDS acoustic neuroma surgery; continuous direct brainstem auditory evoked potential monitoring; oncology aBBreViatiOnS AEDNAP = auditory evoked dorsal cochlear nucleus action potential; AN = acoustic neuroma; APR = amplitude preservation ratio; AUC = area under the curve; BAEP = brainstem auditory-evoked potential; FREMAP = facial nerve root exit zone-elicited compound muscle action potential; GR = Gardner-Robertson; HB = House-Brackmann; M-max = maximum peak-to-peak amplitude; ROC = receiver operating characteristic.

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“…Between peak latencies and interpeak latencies, the latter is the more clinically useful marker because peak latencies are more susceptible to influence from external factors such as age, thus rendering them less reliable. 71 However, the majority of these parameters are, at best, warning signs that alert the surgeon; among them, only maintenance of Waves I and V has been consistently shown to correlate with better postoperative hearing preservation rates, 34,50,88,91,98,121,136,141,146 although others have found poor hearing outcomes despite wave preservation. 30,59 The prognostic power of BAEPs is based solely on the preservation of the waves; in other words, when actual changes are seen on BAEPs, the severity or presence of postoperative deficits cannot be predicted reliably.…”

Section: Brainstem Auditory Evoked Potentialsmentioning

confidence: 99%

Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas

Oh¹,

Nagasawa²,

Fong³

et al. 2012

FOC

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Unfavorable outcomes such as facial paralysis and deafness were once unfortunate probable complications following resection of acoustic neuromas. However, the implementation of intraoperative neuromonitoring during acoustic neuroma surgery has demonstrated placing more emphasis on quality of life and preserving neurological function. A modern review demonstrates a great degree of recent success in this regard. In facial nerve monitoring, the use of modern electromyography along with improvements in microneurosurgery has significantly improved preservation. Recent studies have evaluated the use of video monitoring as an adjunctive tool to further improve outcomes for patients undergoing surgery. Vestibulocochlear nerve monitoring has also been extensively studied, with the most popular techniques including brainstem auditory evoked potential monitoring, electrocochleography, and direct compound nerve action potential monitoring. Among them, direct recording remains the most promising and preferred monitoring method for functional acoustic preservation. However, when compared with postoperative facial nerve function, the hearing preservation is only maintained at a lower rate. Here, the authors analyze the major intraoperative neuromonitoring techniques available for acoustic neuroma resection.

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The prognostic value of intraoperative BAEP patterns in acoustic neurinoma surgery

Cited by 63 publications

References 21 publications

Automated Analysis of the Auditory Brainstem Response Using Derivative Estimation Wavelets

Automated Analysis of the Auditory Brainstem Response Using Derivative Estimation Wavelets

Improved preservation of function during acoustic neuroma surgery

Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas

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