Pelvic pain in terms of an interdisciplinary approach in patient treatment (literature review)

Abstract

The significance of intraoperative neurophysiological monitoring in preserving the facial nerve function is substantial, particularly during surgical removal of giant vestibular schwannomas. The purpose of the study is to analyze the patterns of spontaneous electromyography (EMG) and transcranial corticobulbar motor evoked potentials (MEPs) during resection of giant vestibular schwannomas and assess their correlation with postoperative facial ner ve palsy. Materials and methods. The paper presents a retrospective analysis of the outcomes of surgical treatment of 26 patients with giant vestibular schwannomas (Koos 4, Samii T4b) who underwent surgery in the neurosurgical department of the Interregional Clinical Diagnostic Center between 2022 and 2024. Spontaneous and triggered EMG, corticobulbar MEPs of the facial nerve, somatosensory evoked potentials of bilateral upper extremities, and EMG from the masseter and temporal muscles were used as intraoperative neurophysiological monitoring modalities. Results. Abnormal A-trains were identified in 18 (69.2%) patients during spontaneous EMG. Eight (30.7%) patients exhibited a substantial reduction (exceeding 50%) in the amplitude of corticobulbar MEPs. Postoperatively, five (19.2%) patients experienced severe facial weakness (House-Brackmann grade V-VI). Conversely, eight (30.7%) patients without postoperative facial nerve palsy did not demonstrate pathological A-trains, nor significant decline in corticobulbar MEP amplitude. Conclusion. The method of recording corticobulbar motor evoked potentials is effective in preventing damage to the facial nerve, which is the main goal of intraoperative neurophysiological monitoring in the resection of vestibular schwannomas. The use of spontaneous EMG recording during surgery allows for continuous monitoring of the degree of nerve irritation.