New methodology for facial nerve monitoring in extracranial surgeries of vascular malformations

Ulkatan, Sedat; Waner, Milton; Arranz-Arranz, Beatriz; Weiss, Inanna; O, Theresa M.J.; Mehra, Saral; Deletis, Vedran; Berenstein, Alejandro

doi:10.1016/j.clinph.2013.08.030

Cited by 23 publications

(20 citation statements)

References 14 publications

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“…The investigator must be aware of this possibility so that it does not hinder the FNM. Ulkatan et al needed intensities of up to 40 mA in children with very large malformation, but FNM still was feasible . Electrostimulation under general anesthesia with direct contact to the dissected facial nerve and its branches normally needs less than 2 mA to evoke responses .…”

Section: Discussionmentioning

confidence: 99%

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Altered facial muscle innervation pattern in patients with postparetic facial synkinesis

2019

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Objectives/Hypothesis: Using surface electrostimulation, we aimed to use facial nerve mapping (FNM) in healthy subjects and patients with postparetic facial synkinesis (PPFS) to define functional facial target regions that can be stimulated selectively.Study Design: Single-center prospective cohort study. Methods: FNM was performed bilaterally in 20 healthy subjects and 20 patients with PPFS. Single-pulse surface FNM started at the main trunk of the facial nerve and followed the peripheral branches in a distal direction. Stimulation started with 0.1 mA and increased in 0.1 mA increments. The procedure was simultaneously video recorded and evaluated offline.Results: A total of 1,873 spots were stimulated, and 1,875 facial movements were evaluated. The stimulation threshold was higher on the PPFS side (average = 9.8 AE 1.0 mA) compared to the contralateral side (4.1 AE 0.8 mA) for all stimulation sites or compared to healthy subjects (4.1 AE 0.5 mA; all P < .01). In healthy subjects, selective electrostimulation AE one unintended coactivation was possible at all sites in >80% of cases, with the exception of pulling up the corner of the mouth (65%-75%). On the PPFS side, stimulation was possible for puckering lips movements in 60%/75% (selective stimulation AE one coactivation, respectively), blinking in 55%/80%, pulling up the corner of the mouth in 50%/85%, brow raising in 5%/85, and raising the chin in 0%/35% of patients, respectively.Conclusions: FNM mapping for surgical planning and selective electrostimulation of functional facial regions is possible even in patients with PPFS. FNM may be a tool for patient-specific evaluation and placement of electrodes to stimulate the correct nerve branches in future bionic devices (e.g., for a bionic eye blink).

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Section: Discussionmentioning

confidence: 99%

“…He used the technique to preoperatively visualize the entire course of the extratemporal facial nerve on the skin surface. Preoperative FNM is routinely performed by some groups to plan and guide surgery of facial vascular malformations …”

Section: Introductionmentioning

confidence: 99%

Altered facial muscle innervation pattern in patients with postparetic facial synkinesis

2019

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“…The median preoperative nerve mapping time in the FNM group was 25 minutes (IQR, 16-34 minutes), similar to prior findings. 11 Reduction of actual operative time is not to be underestimated because it is an important means of reducing surgeon stress, infection risk, soft-tissue trauma, and immediate postoperative morbidity. The cost of facial nerve monitoring is difficult to estimate because it varies widely at different institutions.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Facial Nerve Mapping to Plan and Guide Pediatric Facial Vascular Anomaly Resection

Bly

Holdefer

Slimp

et al. 2018

JAMA Otolaryngol Head Neck Surg

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Facial nerve mapping before facial vascular anomaly surgery was associated with less intraoperative facial nerve injury and shorter operative time. Mapping enabled direct identification of individual intralesional and perilesional nerve branches, reducing the need for traditional anterograde facial nerve dissection, and allowed for safe removal of some lesions after partial nerve dissection through transoral or direct excision.

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“…This can be facilitated using either an electrode that is placed on the nerve or near the nerve, by transcranial nerve stimulation or, in the case of vestibulocochlear monitoring, using acoustic stimuli at a given frequency (Hz). Active cIONM has been developed in thyroid surgery [5,8,12,14,21,25,30,32,33], surgery on the posterior cranial fossa [1,2,37,41], and surgery on vascular anomalies [38] where vagus, facial, and vestibulocochlear nerves are at risk. It is important, at this point, to differentiate between iIONM and cIONM, because many authors refer to iIONM as continuous, thus resulting in some confusion.…”

Section: » Modern Ionm Has Prognostic Implications For Intraoperativementioning

confidence: 99%

“…Another extracranial method of facial nerve neuromonitoring is percutaneous stimulation. Ulkatan and colleagues used two monopolar EMG needles during surgery on facial vascular malformations, introducing them percutaneously toward the stylomastoid foramen [38].…”

Section: Acionm In Vascular Malformation Surgerymentioning

confidence: 99%

Continuous intraoperative neuromonitoring (cIONM) in head and neck surgery—a review

Stankovic

Wittlinger

Georgiew

et al. 2020

HNO

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Although the history of intraoperative neuromonitoring (IONM) dates back to the 19th century, the method did not evolve further than the mere differentiation of nerves until recently. Only the development of continuous IONM (cIONM) has allowed for non-stop analysis of excitation amplitude and latency during surgical procedures, which is nowadays integrated into the software of almost all commercially available neuromonitoring devices. The objective of cIONM is real-time monitoring of nerve status in order to recognize and prevent impending nerve injury and predict postoperative nerve function. Despite some drawbacks such as false-positive/negative alarms, technical artefacts, and rare adverse effects, cIONM remains a good instrument which is still under development. Active (acIONM) and passive (pcIONM) methods of cIONM are described in literature. The main fields of cIONM implementation are currently thyroid surgery (in which the vagal nerve is continuously stimulated) and surgery to the cerebellopontine angle (in which the facial nerve is either continuously stimulated or the discharge signal of the nerve is analyzed via pcIONM). In the latter surgery, continuous monitoring of the cochlear nerve is also established.

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New methodology for facial nerve monitoring in extracranial surgeries of vascular malformations

Cited by 23 publications

References 14 publications

Altered facial muscle innervation pattern in patients with postparetic facial synkinesis

Altered facial muscle innervation pattern in patients with postparetic facial synkinesis

Preoperative Facial Nerve Mapping to Plan and Guide Pediatric Facial Vascular Anomaly Resection

Continuous intraoperative neuromonitoring (cIONM) in head and neck surgery—a review

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