Intraoperative Transcranial Motor-Evoked Potential Monitoring of the Facial Nerve during Cerebellopontine Angle Tumor Resection

Cosetti, Maura K.; Xu, Min; Rivera, Andrew; Kuhn, Maggie A.; Golfinos, John G.; Roland, J. Thomas

doi:10.1055/s-2011-1274248

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…Numerous reports have shown intraoperative FMEP to be highly predictive of immediate and long-term postoperative facial function. 5-8,29 In a large retrospective study, Bhimrao et al 8 investigated the value of intraoperative FMEP monitoring in 367 consecutive patients who underwent primary resection of sporadic VS. The authors found that final-to-baseline FMEP ratios of 0.62 (PPV 0.96) and 0.59 (PPV 0.98) predicted HB grade 1 or 2 immediately postoperatively and at 1 year after surgery, respectively.…”

Section: Discussionmentioning

confidence: 99%

Impact of Motor-Evoked Potential Monitoring on Facial Nerve Outcomes after Vestibular Schwannoma Resection

Tawfik

Walters

Kohlberg

et al. 2018

Ann Otol Rhinol Laryngol

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Objectives: Assess the utility of intraoperative transcranial facial motor-evoked potential (FMEP) monitoring in predicting and improving facial function after vestibular schwannoma (VS) resection. Study Design: Retrospective chart review. Methods: Data were obtained from 82 consecutive VS resections meeting inclusion criteria. Sixty-two cases were performed without FMEP and 20 with FMEP. Degradation of FMEP response was defined as a final-to-baseline amplitude ratio of 0.5 or less. House-Brackmann (HB) grade was assessed preoperatively, postoperatively, at follow-up assessments, and it was compared between pre-and post-FMEP cohorts. Positive predictive value (PPV) and negative predictive value (NPV), sensitivity, and specificity of FMEP degradation in predicting facial weakness were calculated. Results: In the pre-FMEP group, at length of follow-up (LOF) ⩾9 months, 83.9% (52/62) of patients exhibited HB 1-2 outcome. In the post-FMEP cohort, 75.0% (15/20) exhibited HB 1-2 function at LOF ⩾9 months. There was no difference in rates of HB 1-2 outcomes between groups in the immediate postoperative period (P = .35) or at long-term follow-up (P = 1.0). With respect to predicting immediate postoperative facial function, FMEP demonstrated high specificity (88.9%) and moderate sensitivity (54.5%). The PPV and NPV for immediate postoperative facial function were 85.7% and 61.5%, respectively. With respect to long-term (⩾9 months LOF) facial function, intraoperative FMEP was moderately sensitive (71.4%) and highly specific (84.6%); PPV was moderate (71.4%), and NPV was high (84.6%). Conclusions: Intraoperative FMEP is highly specific and moderately sensitive in predicting postoperative facial function for patients undergoing VS resection, but its use may not be associated with improved facial nerve outcomes.

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Section: Discussionmentioning

confidence: 99%

Impact of Motor-Evoked Potential Monitoring on Facial Nerve Outcomes after Vestibular Schwannoma Resection

Tawfik

Walters

Kohlberg

et al. 2018

Ann Otol Rhinol Laryngol

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“…However, it remains impossible to locate the facial nerve with these two monitoring methods; hence, they cannot replace the role of stimulated-EMG in acoustic neuroma surgery (16). In short, A-train and MEP can predict facial nerve functioning to some extent (17) but cannot map the facial nerve (18)(19)(20). The monitoring method in use the longest comprises a combination of traditional freerunning and stimulated EMGs.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological mapping and assessment of facial nerve functioning during acoustic neuroma operations

Li¹,

Bao²,

Liang³

et al. 2021

Ann Transl Med

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Background: Electrophysiological monitoring is used routinely to protect the facial nerve during acoustic neuroma surgery. This study aimed to clarify the relationship between the facial nerve's electrophysiological monitoring parameters and its function after surgery.Methods: Fifty-two patients with acoustic neuroma who underwent surgery were included. After localizing the facial nerve, its monitoring results during surgeries performed at our center were analyzed. Postoperative nerve functioning was correlated with the stimulation threshold of the facial nerve's proximal segment, proximal-to-distal amplitude ratio of the facial nerve, and proximal stimulation amplitude. Receiveroperating characteristic curves of the three parameters were calculated.Results: Electrical stimulation accurately described the facial nerve's anatomic distribution after the depth of anesthesia was assessed via accessory nerve stimulation. The data recorded after resection showed that a higher proximal-to-distal amplitude ratio was associated with better facial nerve functioning (P=0.037). A lower stimulation threshold of the proximal segment correlated with better facial nerve functioning (P=0.038). Conclusions:The most sensitive index to predict postoperative nerve functioning is the facial nerve's proximal-to-distal amplitude ratio. Accessory nerve stimulation can determine the appropriate depth of anesthesia, Electromyography (EMG) monitoring of the facial nerve during acoustic neuroma surgery can protect it effectively.

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Intraoperative Transcranial Motor-Evoked Potential Monitoring of the Facial Nerve during Cerebellopontine Angle Tumor Resection

Cited by 2 publications

References 20 publications

Impact of Motor-Evoked Potential Monitoring on Facial Nerve Outcomes after Vestibular Schwannoma Resection

Impact of Motor-Evoked Potential Monitoring on Facial Nerve Outcomes after Vestibular Schwannoma Resection

Electrophysiological mapping and assessment of facial nerve functioning during acoustic neuroma operations

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