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Prado MB, Kubota Y. Utility and Prognostic Value of Intraoperative Blink Reflex in Trigeminal or Facial Nerve Monitoring in Skull Base Surgeries: A Systematic Review. World Neurosurg 2024; 187:e759-e768. [PMID: 38705267 DOI: 10.1016/j.wneu.2024.04.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Blink reflex (BR) is an oligosynaptic reflex that involves the ophthalmic branch of the trigeminal nerve (TN), ipsilateral main sensory and trigeminospinal nuclei, bilateral facial nuclei, and the facial nerves (FNs). Theoretically, as BR tests the function of both TN and FNs simultaneously, it is an ideal tool for monitoring the status of TN and FNs during skull base surgeries. Nevertheless, it has been used only recently in surgeries as the use of anesthesia limits its use. METHODS For this systematic review, 2 authors input the search terms [(Blink Reflex) AND (Intraoperative Neuromonitoring OR Neuro Intraoperative Monitoring OR Intraoperative OR NIOM OR IONM) AND (skull base surgery OR Facial Nerve OR Trigeminal Nerve OR Microvascular Decompression OR Hemifacial Spasm)] in MEDLINE through its PubMed interface and other search engines. Articles that fulfilled the inclusion and exclusion criteria were obtained and scrutinized. RESULTS Seven observational articles with a total of 437 participants were included. All 5 studies that described the use of BR in FN surgery noted that intraoperative BR is beneficial, safe, sensitive, specific, and predictive of outcomes, while 2 articles describing patients with trigeminal neuralgia recommended use of BR in microvascular decompression of TN. CONCLUSIONS Intraoperative BR is a sensitive, specific, and safe monitoring technique that has good predictability of facial paresis and paresthesia among patients undergoing MVD for trigeminal neuralgia and primary hemifacial spasm and patients undergoing cerebellopontine angle tumor resection.
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Affiliation(s)
- Mario B Prado
- Department of Neurosurgery, Tokyo Women Medical University - Adachi Medical Center, Tokyo, Japan; Department of Physiology, College of Medicine, University of the Philippines, Manila, Philippines.
| | - Yuichi Kubota
- Department of Neurosurgery, Tokyo Women Medical University - Adachi Medical Center, Tokyo, Japan
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Kofler M, Hallett M, Iannetti GD, Versace V, Ellrich J, Téllez MJ, Valls-Solé J. The blink reflex and its modulation - Part 1: Physiological mechanisms. Clin Neurophysiol 2024; 160:130-152. [PMID: 38102022 PMCID: PMC10978309 DOI: 10.1016/j.clinph.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/11/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023]
Abstract
The blink reflex (BR) is a protective eye-closure reflex mediated by brainstem circuits. The BR is usually evoked by electrical supraorbital nerve stimulation but can be elicited by a variety of sensory modalities. It has a long history in clinical neurophysiology practice. Less is known, however, about the many ways to modulate the BR. Various neurophysiological techniques can be applied to examine different aspects of afferent and efferent BR modulation. In this line, classical conditioning, prepulse and paired-pulse stimulation, and BR elicitation by self-stimulation may serve to investigate various aspects of brainstem connectivity. The BR may be used as a tool to quantify top-down modulation based on implicit assessment of the value of blinking in a given situation, e.g., depending on changes in stimulus location and probability of occurrence. Understanding the role of non-nociceptive and nociceptive fibers in eliciting a BR is important to get insight into the underlying neural circuitry. Finally, the use of BRs and other brainstem reflexes under general anesthesia may help to advance our knowledge of the brainstem in areas not amenable in awake intact humans. This review summarizes talks held by the Brainstem Special Interest Group of the International Federation of Clinical Neurophysiology at the International Congress of Clinical Neurophysiology 2022 in Geneva, Switzerland, and provides a state-of-the-art overview of the physiology of BR modulation. Understanding the principles of BR modulation is fundamental for a valid and thoughtful clinical application (reviewed in part 2) (Gunduz et al., submitted).
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Affiliation(s)
- Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria.
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, NIH, USA.
| | - Gian Domenico Iannetti
- University College London, United Kingdom; Italian Institute of Technology (IIT), Rome, Italy.
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Vipiteno-Sterzing, Italy.
| | - Jens Ellrich
- Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
| | | | - Josep Valls-Solé
- IDIBAPS (Institut d'Investigació August Pi i Sunyer), University of Barcelona, Spain.
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Simioni V, Capone JG, Sette E, Granieri E, Farneti M, Cavallo MA, Tugnoli V. Intraoperative monitoring of sensory part of the trigeminal nerve using blink reflex during microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 2018; 160:165-169. [PMID: 29177630 DOI: 10.1007/s00701-017-3405-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/13/2017] [Indexed: 11/26/2022]
Abstract
Intraoperative monitoring during cerebellopontine angle surgery is widely accepted. While techniques which monitor cranial motor nerves are commonly used, monitoring the sensory afferents has been challenging. Considering the reflex arc, blink reflex (BR) might be useful in monitoring the sensory part of the trigeminal nerve, the brainstem connections and the facial nerve. We describe the case of a patient who developed hemifacial hypoesthesia after microvascular decompression surgery for trigeminal neuralgia. Intraoperative BR showed a severe loss of R1 amplitude. BR might be a useful intraoperative technique to monitor the sensory part of the trigeminal nerve.
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Affiliation(s)
- Valentina Simioni
- Department of Neuroscience and Rehabilitation, Division of Neurology, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy.
| | - J G Capone
- Department of Neuroscience and Rehabilitation, Division of Neurology, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
| | - E Sette
- Department of Neuroscience and Rehabilitation, Division of Neurology, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
| | - E Granieri
- Department of Biomedical and Surgical Science, Section of Neurological, Psychiatric and Psychological Sciences, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
| | - M Farneti
- Department of Neuroscience and Rehabilitation, Division of Neurosurgery, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
| | - M A Cavallo
- Department of Neuroscience and Rehabilitation, Division of Neurosurgery, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
| | - V Tugnoli
- Department of Neuroscience and Rehabilitation, Division of Neurology, 'S. Anna' University-Hospital, Via Aldo Moro 8, 44121, Cona, Ferrara, Italy
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de Lestrange-Anginieur E, Jiang X, Ren Q. Optical modelling of a supplementary tunable air-spaced goggle lens for rodent eye imaging. PLoS One 2017; 12:e0181111. [PMID: 28727809 PMCID: PMC5519152 DOI: 10.1371/journal.pone.0181111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 06/25/2017] [Indexed: 11/26/2022] Open
Abstract
Aberration variations severely degrade retinal imaging in small animal eyes. Previously, the approach of a goggle lens with a matching corneal index was proposed to overcome the on-axis resolution limit of static imaging systems, which allows the use of the full eye pupil. But this technique didn’t address the problem of the large power variation, and the ensuing aberration on and off-axis, when dealing with small animal eyes. In this study, we present the concept of a tunable goggle lens, designed to compensate individual ocular aberration for different rodent eye powers. Ray tracing evidences that lens-fitted goggles permit, not only to adjust individual eyes power, but also to surpass conventional adaptive correction technique over large viewing angle, provided a minimum use of two spaced liquids. We believe that the overlooked advantage of the 3D lens function is a seminal finding for further technological advancements in widefield retinal imaging.
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Affiliation(s)
- Elie de Lestrange-Anginieur
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, P.R. China
- * E-mail:
| | - Xiaoyun Jiang
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, P.R. China
| | - Qiushi Ren
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, P.R. China
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Recordings of long-latency trigeminal somatosensory-evoked potentials in patients under general anaesthesia. Clin Neurophysiol 2011; 122:1048-54. [DOI: 10.1016/j.clinph.2010.08.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Revised: 08/20/2010] [Accepted: 08/21/2010] [Indexed: 11/17/2022]
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Sekula RF, Bhatia S, Frederickson AM, Jannetta PJ, Quigley MR, Small GA, Breisinger R. Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis. Neurosurg Focus 2009; 27:E10. [DOI: 10.3171/2009.8.focus09142] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this paper, the authors' goal was to determine the utility of monitoring the abnormal muscle response (AMR) or “lateral spread” during microvascular decompression surgery for hemifacial spasm.
Methods
The authors' experience with AMR as well as the data available in the English-language literature regarding resolution or persistence of AMR and the resolution or persistence of hemifacial spasm at follow-up was pooled and subjected to a meta-analysis.
Results
The pooled OR revealed by the meta-analysis was 4.2 (95% CI 2.7–6.7). The chance of a cure if the AMR was abolished during surgery was 4.2 times greater than if the lateral spread persisted.
Conclusions
The AMR should be monitored routinely in the operating room, and surgical decision-making in the operating room should be augmented by the AMR.
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Deletis V, Urriza J, Ulkatan S, Fernandez-Conejero I, Lesser J, Misita D. The feasibility of recording blink reflexes under general anesthesia. Muscle Nerve 2009; 39:642-6. [DOI: 10.1002/mus.21257] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Mourisse J, Gerrits W, Lerou J, van Egmond J, Zwarts MJ, Booij L. Electromyographic assessment of blink and corneal reflexes during midazolam administration: useful methods for assessing depth of anesthesia? Acta Anaesthesiol Scand 2003; 47:593-600. [PMID: 12699519 DOI: 10.1034/j.1399-6576.2003.00100.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are at least three components of the anesthetic state: loss of consciousness, amnesia and obtundation of reflex responses to noxious stimuli. To investigate the third component, we used a standard electrical stimulus to evoke a blink reflex, which was electromyographically recorded. These data may give information on the anesthetic state. METHODS The relation between the electrically evoked blink and corneal reflexes and the depth of sedation and anesthesia induced with intravenous midazolam was investigated. Ten patients received i.v. increments of midazolam (1 mg, 2 mg, 3 mg, 3 mg, 3 mg, etc., until a 21-mg total dose) to create a step-wise deepening of sedation and anesthesia. Depth of anesthesia was assessed by the Observer's Assessment of Alertness/Sedation (OAAS) scale, ranging from 5 ( = awake and alert) to 0 ( = no motor response to tetanic stimulation). RESULTS Latency of the first (R1) and second (R2) blink components and the corneal (C) reflex component increased, whereas duration and area decreased with increasing depth of sedation and anesthesia. R1 was last seen at an OAAS score [mean (SD)] of 1.8 (0.8), R2 at a score of 3.1 (1.1), C at a score of 3.8 (0.8), and R3 at 4.8 (0.5). These end-points were all statistically different from each other, except R2 vs. C. CONCLUSIONS Our results suggest that the differential sensitivity of the components of the blink reflex could be useful to monitor depth of sedation and light levels of anesthesia during the administration of midazolam.
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Affiliation(s)
- J Mourisse
- Department of Anesthesiology, University Medical Center Nijmegen, HB, Nijmegen, The Netherlands.
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Albers JW, Wald JJ, Trask CL, Garabrant DH, Berent S. Evaluation of blink reflex results obtained from workers previously diagnosed with solvent-induced toxic encephalopathy. J Occup Environ Med 2001; 43:713-22. [PMID: 11515255 DOI: 10.1097/00043764-200108000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We reviewed blink reflexes recorded from 51 railroad workers with long-term occupational exposure to solvents who were diagnosed by others with solvent-induced toxic encephalopathy. No worker fulfilled conventional clinical criteria for dementia or trigeminal mononeuropathy. All workers had normal R1 and R2 blink reflex latencies. R1 latencies correlated significantly with several nerve conduction measures, including F wave latencies, suggesting that some intersubject variability reflected intrinsic conduction properties, not isolated brain-stem function. Although normal, the workers' R1 latencies were significantly prolonged compared with historical control groups, including gender-matched control subjects of similar mean age (11.2 ms vs 9.9 ms; P < 0.0001). Stepwise multiple regression models demonstrated significant associations of R1 latency with age and use of CNS-active prescription medications (P = 0.003), but duration of occupational solvent exposure did not enter into the models. Paradoxically, workers using CNS-active medications had significantly shorter R1 latencies compared with workers not using such medications (10.9 vs 11.7 ms; P = 0.01). Job title, another potential surrogate measure of exposure, was not significantly related to reflex latencies. The geographical site of predominant solvent exposure did influence R1 latency, and workers from one site had longer exposure duration and longer R1 latencies than remaining workers. However, an interaction between age and exposure duration (r = 0.39; P = 0.003) confounded interpretation of this observation. Disability or work status, mental status findings, or classification of encephalopathy did not influence blink reflex latencies. The overall results do not support, but do not entirely exclude, a possible relationship between subclinical blink reflex abnormalities and occupational exposure to solvents. Nevertheless, it is clear from these results that the small group differences in R1 latency between exposed workers and control subjects are of no diagnostic importance and of uncertain physiologic importance, and they may reflect unrecognized confounders and technical factors.
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Affiliation(s)
- J W Albers
- Departments of Neurology and Psychiatry, Neurobehavioral Toxicology Program, University of Michigan Health System, USA
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