Hearing outcomes following microvascular decompression for hemifacial spasm

Shah, Aalap; Nikonow, Tara; Hirsch, Barry E.; Chang, Yue‐Fang; Gardner, Paul A.; Balzer, Jeffrey; Habeych, Miguel; Crammond, Donald J.; Burkhart, Lois; Horowitz, Michael

doi:10.1016/j.clineuro.2012.01.016

Cited by 23 publications

(15 citation statements)

References 27 publications

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“…Auditory nerve function was monitored using brainstem auditory evoked potentials, performed with our institution's alarm criteria. 23 Physician oversight and interpretation of neurophysiological responses (such as brainstem auditory evoked potentials, lateral spread responses, and electromyography from cranial nerves) was performed using a combined on-site and remote model used by the University of Pittsburgh Medical Center. 26 …”

Section: Intraoperative Neurophysiological Monitoring and Alarm Criteriamentioning

confidence: 99%

Effect of previous botulinum neurotoxin treatment on microvascular decompression for hemifacial spasm

Wang

Shah

Gardner

et al. 2013

FOC

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Object The objective of this study was to investigate the clinical characteristics, intraoperative findings, complications, and outcomes after the first microvascular decompression (MVD) in patients with and without previous botulinum neurotoxin treatment for hemifacial spasm (HFS). Methods The authors analyzed 246 MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000, and December 31, 2007. One hundred and seventy-six patients with HFS underwent botulinum neurotoxin injection treatment prior to first MVD (Group I), and 70 patients underwent their first MVD without previous botulinum neurotoxin treatment (Group II). Clinical outcome data were obtained immediately after the operation, at discharge, and at follow-up. Follow-up data were collected from 177 patients with a minimum follow-up period of 9 months (mean 54.48 ± 27.84 months). Results In 246 patients, 89.4% experienced immediate postoperative relief of spasm, 91.1% experienced relief at discharge, and 92.7% experienced relief at follow-up. There was no significant difference in outcomes and complications between Group I and Group II (p > 0.05). Preoperatively, patients in Group I had higher rates of facial weakness, tinnitus, tonus, and platysmal involvement as compared with Group II (p < 0.05). The posterior inferior cerebellar artery and vertebral artery were intraoperatively identified as the offending vessels in cases of vasculature compression in a significantly greater number of patients in Group II compared with Group I (p = 0.008 and p = 0.005, respectively, for each vessel). The lateral spread response (LSR) disappeared in 60.48% of the patients in Group I as compared with 74.19% in Group II (p > 0.05). No significant differences in complications were noted between the 2 groups. Conclusions Microvascular decompression is an effective and safe procedure for patients with HFS previously treated using botulinum neurotoxin. Intraoperative monitoring with LSR is an effective tool for evaluating adequate decompression.

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Section: Intraoperative Neurophysiological Monitoring and Alarm Criteriamentioning

confidence: 99%

Effect of previous botulinum neurotoxin treatment on microvascular decompression for hemifacial spasm

Wang

Shah

Gardner

et al. 2013

FOC

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“…The use of BAEPs practically extinguished the hearing loss complication after MVDs since the 1980s (Møller and Møller, 1989;Radtke et al, 1989), except maybe for the persistent high-tone hypoacusis, still not totally explained, which we recently reported (Sha et al, 2012). The use of BAEPs practically extinguished the hearing loss complication after MVDs since the 1980s (Møller and Møller, 1989;Radtke et al, 1989), except maybe for the persistent high-tone hypoacusis, still not totally explained, which we recently reported (Sha et al, 2012).…”

Section: Discussionmentioning

confidence: 90%

Intraoperative Neurophysiological Monitoring of Microvascular Decompression for Glossopharyngeal Neuralgia

Habeych

Crammond

Gardner

et al. 2014

Journal of Clinical Neurophysiology

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“…BAEP changes can be measured by changes in latency and amplitude of waveforms, though wave V is the most prominent. 31 A larger decrease in brainstem blood flow causes changes in the amplitudes of SSEP and BAEP. 3 Monitoring SSEP and BAEP for tumors in proximity to the brainstem can provide a multimodal approach that protects the brainstem's sensory and auditory pathways since the blood supply to the brainstem consists of single end arteries, and a sudden change in 1 pathway may not be reflective of changes in the other pathway.…”

Section: Ssep and Baepmentioning

confidence: 99%

“…For SSEPs, a 10% increase in latency or 50% decrease in amplitude relative to baseline was considered clinically significant. 31,[35][36][37] Changes in more than 2 consecutive averaged trials were considered persistent changes. The absence of free-run EMG activity was considered baseline in each case.…”

Section: Alarm Criteriamentioning

confidence: 99%

Intraoperative neurophysiological monitoring during endoscopic endonasal surgery for pediatric skull base tumors

Elangovan¹,

Singh²,

Gardner³

et al. 2016

PED

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OBJECT The aim of this study was to evaluate the value of intraoperative neurophysiological monitoring (IONM) using electromyography (EMG), brainstem auditory evoked potentials (BAEPs), and somatosensory evoked potentials (SSEPs) to predict and/or prevent postoperative neurological deficits in pediatric patients undergoing endoscopic endonasal surgery (EES) for skull base tumors. METHODS All consecutive pediatric patients with skull base tumors who underwent EES with at least 1 modality of IONM (BAEP, SSEP, and/or EMG) at our institution between 1999 and 2013 were retrospectively reviewed. Staged procedures and repeat procedures were identified and analyzed separately. To evaluate the diagnostic accuracy of significant free-run EMG activity, the prevalence of cranial nerve (CN) deficits and the sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS A total of 129 patients underwent 159 procedures; 6 patients had a total of 9 CN deficits. The incidences of CN deficits based on the total number of nerves monitored in the groups with and without significant free-run EMG activity were 9% and 1.5%, respectively. The incidences of CN deficits in the groups with 1 staged and more than 1 staged EES were 1.5% and 29%, respectively. The sensitivity, specificity, and negative predictive values (with 95% confidence intervals) of significant EMG to detect CN deficits in repeat procedures were 0.55 (0.22–0.84), 0.86 (0.79–0.9), and 0.97 (0.92–0.99), respectively. Two patients had significant changes in their BAEPs that were reversible with an increase in mean arterial pressure. CONCLUSIONS IONM can be applied effectively and reliably during EES in children. EMG monitoring is specific for detecting CN deficits and can be an effective guide for dissecting these procedures. Triggered EMG should be elicited intraoperatively to check the integrity of the CNs during and after tumor resection. Given the anatomical complexity of pediatric EES and the unique challenges encountered, multimodal IONM can be a valuable adjunct to these procedures.

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Hearing outcomes following microvascular decompression for hemifacial spasm

Cited by 23 publications

References 27 publications

Effect of previous botulinum neurotoxin treatment on microvascular decompression for hemifacial spasm

Effect of previous botulinum neurotoxin treatment on microvascular decompression for hemifacial spasm

Intraoperative Neurophysiological Monitoring of Microvascular Decompression for Glossopharyngeal Neuralgia

Intraoperative neurophysiological monitoring during endoscopic endonasal surgery for pediatric skull base tumors

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