BACKGROUND: Preservation of facial nerve function is one of the most important goals in acoustic neuroma surgery. We have been using intraoperative continuous monitoring of evoked facial nerve electromyograms (EMGs) since 1997 in acoustic neuroma surgery. We therefore investigated surgically treated patients to clarify the usefulness of this monitoring, and to determine safety criteria for preserving facial nerve function. METHODS: This intraoperative continuous monitoring of evoked facial nerve EMG is a method for checking the EMG evoked by continuous direct electrical stimulation of the facial nerve during tumor excision. The greatest advantage of this method is the ability to identify changes in EMG in real time. We retrospectively investigated 216 patients with surgically treated acoustic neuroma to identify correlations between parameters in this monitoring and postoperative facial nerve function immediately and 1 year after surgery. RESULTS: In these patients, the functional preservation rate of the facial nerve (House and Brackmann grade 1 or 2 at 1 year after surgery) was 98.6% with a 98.2% mean tumor resection rate. Amplitude preservation ratio correlated significantly with facial nerve function both immediately and 1 year after surgery. To avoid severe facial nerve palsy, a warning criterion of amplitude preservation ratio >50% appears useful. CONCLUSIONS: Postoperative course of facial nerve function appears predictable using intraoperative continuous monitoring of evoked facial nerve EMGs. This monitoring is useful to increase the tumor excision rate while avoiding severe postoperative facial nerve palsy in acoustic neuroma surgery.
BACKGROUND: Preservation of facial nerve function is one of the most important goals in acoustic neuroma surgery. We have been using intraoperative continuous monitoring of evoked facial nerve electromyograms (EMGs) since 1997 in acoustic neuroma surgery. We therefore investigated surgically treated patients to clarify the usefulness of this monitoring, and to determine safety criteria for preserving facial nerve function. METHODS: This intraoperative continuous monitoring of evoked facial nerve EMG is a method for checking the EMG evoked by continuous direct electrical stimulation of the facial nerve during tumor excision. The greatest advantage of this method is the ability to identify changes in EMG in real time. We retrospectively investigated 216 patients with surgically treated acoustic neuroma to identify correlations between parameters in this monitoring and postoperative facial nerve function immediately and 1 year after surgery. RESULTS: In these patients, the functional preservation rate of the facial nerve (House and Brackmann grade 1 or 2 at 1 year after surgery) was 98.6% with a 98.2% mean tumor resection rate. Amplitude preservation ratio correlated significantly with facial nerve function both immediately and 1 year after surgery. To avoid severe facial nerve palsy, a warning criterion of amplitude preservation ratio >50% appears useful. CONCLUSIONS: Postoperative course of facial nerve function appears predictable using intraoperative continuous monitoring of evoked facial nerve EMGs. This monitoring is useful to increase the tumor excision rate while avoiding severe postoperative facial nerve palsy in acoustic neuroma surgery.
Authors: Orlando Guntinas-Lichius; Carl E Silver; Jovanna Thielker; Manuel Bernal-Sprekelsen; Carol R Bradford; Remco De Bree; Luis P Kowalski; Kerry D Olsen; Miquel Quer; Alessandra Rinaldo; Juan R Rodrigo; Alvaro Sanabria; Ashok R Shaha; Robert P Takes; Vincent Vander Poorten; Peter Zbären; Alfio Ferlito Journal: Eur Arch Otorhinolaryngol Date: 2018-09-28 Impact factor: 2.503
Authors: Randall A Bly; Robert N Holdefer; Jefferson Slimp; Gregory A Kinney; Vicente Martinez; Scott C Manning; Jonathan A Perkins Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-05-01 Impact factor: 6.223
Authors: Kathleen Seidel; Matthias S Biner; Irena Zubak; Jonathan Rychen; Jürgen Beck; Andreas Raabe Journal: Neurosurg Rev Date: 2018-10-26 Impact factor: 3.042