Intraoperative brainstem auditory evoked potentials

Radtke, Rodney A.; Erwin, C. W.; Wilkins, Robert H.

doi:10.1212/wnl.39.2.187

Cited by 122 publications

(49 citation statements)

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“…Controlled studies are not available to determine whether or not cranial nerve monitoring during MCF surgery reduces the risk of postoperative ophthalmoplegia, 22 although there are controlled data to suggest that monitoring reduces the risk of cranial nerve injury in selected situations (e.g., facial nerve during acoustic schwannoma resection, and auditory nerve during acoustic schwannoma and microvascular decompression for hemifacial spasm). [23][24][25] …”

Section: Discussionmentioning

confidence: 99%

Transzygomatic Approach with Intraoperative Neuromonitoring for Resection of Middle Cranial Fossa Tumors

et al. 2011

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Access to the floor of the middle cranial fossa (MCF) is often required when performing cranial base approaches to expose various lesions of the petrous apex, petroclival junction, internal auditory canal, and posterior cavernous sinus. In many patients with these lesions, a temporal craniotomy is sufficient to reach the floor of the MCF. However, the caudal limit of a simple temporal craniotomy is the zygomatic arch, which can present an obstacle in accessing the MCF in some individuals. Several authors have advocated mobilizing the zygomatic arch by performing a simple zygomatic osteotomy or using extended frontotemporo-orbitozygomatic approaches to reach low-lying lesions. [1][2][3] Intraoperative neuromonitoring (IOM) is one of the methods in which modern neurosurgery can improve surgical results while reducing morbidity. Motor-evoked potentials (MEPs) obtained by transcranial electrocortical stimulation is routinely used to monitor major motor pathways intraoperatively during several neurosurgical procedures. 4-6 Monitoring of oculomotor, trochlear, trigeminal, and facial nerve function is usually performed using free-running electromyography (EMG) or by direct stimulation of each cranial nerve. 7-9 Keywords ► middle fossa approach ► skull base surgery ► motor-evoked potentials ► intraoperative monitoring ► neurophysiology AbstractThe authors reviewed the surgical experience and operative technique in a series of 11 patients with middle fossa tumors who underwent surgery using the transzygomatic approach and intraoperative neuromonitoring (IOM) at a single institution. This approach was applied to trigeminal schwannomas (n ¼ 3), cavernous angiomas (n ¼ 3), sphenoid wing meningiomas (n ¼ 3), a petroclival meningioma (n ¼ 1), and a hemangiopericytoma (n ¼ 1). An osteotomy of the zygoma, a low-positioned frontotemporal craniotomy, removal of the remaining squamous temporal bone, and extradural drilling of the sphenoid wing made a flat trajectory to the skull base. Total resection was achieved in 9 of 11 patients. Significant motor pathway damage can be avoided using a change in motor-evoked potentials as an early warning sign. Four patients experienced cranial nerve palsies postoperatively, even though free-running electromyography of cranial nerves showed normal responses during the surgical procedure. A simple transzygomatic approach provides a wide surgical corridor for accessing the cavernous sinus, petrous apex, and subtemporal regions. Knowledge of the middle fossa structures is essential for anatomic orientation and avoiding injuries to neurovascular structures, although a neuronavigation system and IOM helps orient neurosurgeons.

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Section: Discussionmentioning

confidence: 99%

Transzygomatic Approach with Intraoperative Neuromonitoring for Resection of Middle Cranial Fossa Tumors

et al. 2011

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“…Intraoperative monitoring (IOM) of neural function is used to warn of the risk of surgical complications. [1][2][3][4][5][6] Anesthesiologists and surgeons are able to intervene in a variety of ways when IOM raises warnings. They can modify surgery by interventions such as reducing the degree of distraction, adjusting retractors, removing or adjusting grafts or hardware, reimplanting or unclamping arteries, placing vascular bypass grafts, minimizing the remaining portion of the surgery, or other actions.…”

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confidence: 99%

Evidence-based guideline update: Intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials

et al. 2012

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Objective:To evaluate whether spinal cord intraoperative monitoring (IOM) with somatosensory and transcranial electrical motor evoked potentials (EPs) predicts adverse surgical outcomes. Methods:A panel of experts reviewed the results of a comprehensive literature search and identified published studies relevant to the clinical question. These studies were classified according to the evidence-based methodology of the American Academy of Neurology. Objective outcomes of postoperative onset of paraparesis, paraplegia, and quadriplegia were used because no randomized or masked studies were available. Results and Recommendations:Four Class I and 8 Class II studies met inclusion criteria for analysis. The 4 Class I studies and 7 of the 8 Class II studies reached significance in showing that paraparesis, paraplegia, and quadriplegia occurred in the IOM patients with EP changes compared with the IOM group without EP changes. All studies were consistent in showing all occurrences of paraparesis, paraplegia, and quadriplegia in the IOM patients with EP changes, with no occurrences of paraparesis, paraplegia, and quadriplegia in patients without EP changes. In the Class I studies, 16%-40% of the IOM patients with EP changes developed postoperative-onset paraparesis, paraplegia, or quadriplegia. IOM is established as effective to predict an increased risk of the adverse outcomes of paraparesis, paraplegia, and quadriplegia in spinal surgery (4 Class I and 7 Class II studies). Surgeons and other members of the operating team should be alerted to the increased risk of severe adverse neurologic outcomes in patients with important IOM changes (Level A). Neurology

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“…Intraoperative ABR monitoring is a useful aid in hearing preservation by warning the surgeon of operative events that threaten the integrity of the cochlear nerve. 10,19,23,26,27 Moreover, it can significantly improve the rate of surgery-related hearing impairment, especially in small tumors. 7 However, ABR has shortcomings for IOM.…”

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confidence: 99%

Superiority of tympanic ball electrodes over mastoid needle electrodes for intraoperative monitoring of hearing function

Krieg¹,

Kempf²,

Droese

et al. 2014

JNS

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Intraoperative brainstem auditory evoked potentials

Cited by 122 publications

References 0 publications

Transzygomatic Approach with Intraoperative Neuromonitoring for Resection of Middle Cranial Fossa Tumors

Transzygomatic Approach with Intraoperative Neuromonitoring for Resection of Middle Cranial Fossa Tumors

Evidence-based guideline update: Intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials

Superiority of tympanic ball electrodes over mastoid needle electrodes for intraoperative monitoring of hearing function

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