1
|
Zhang Y, Zhou E, Xue X, Chen X. Intraoperative brainstem auditory evoked potential monitoring during cerebellopontine angle surgery via retrosigmoid approach. EAR, NOSE & THROAT JOURNAL 2023:1455613221150574. [PMID: 36680392 DOI: 10.1177/01455613221150574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Brainstem auditory evoked potential (BAEP) monitoring was used to identify the influence of auditory function during cerebellopontine angle (CPA) surgery for cranial neuropathy via the retrosigmoid approach. METHODS This prospective study included 20 patients who underwent CPA surgery for cranial neuropathy via the retrosigmoid approach with intraoperative BAEP monitoring and pure tone audiometry (PTA). The latency and interpeak latency were analyzed at each surgical step in combination with the pre- and postoperative PTA. RESULTS Follow-up data were available for 17 patients. The mean pre- and postoperative PTA values were 25.65 dB and 20.70 dB, respectively. Two patients (2/17, 11.76%) developed hearing loss postoperatively. The latency of wave І significantly changed during direct auditory nerve manipulation and at the end of the surgery, while that of wave III only changed during direct auditory nerve manipulation. The appearance of wave V peak was delayed during CPA surgery. CONCLUSIONS CPA surgery for cranial neuropathy via the retrosigmoid approach can cause hearing loss to varying degrees, and intraoperative BAEP monitoring can reduce the occurrence of hearing loss. Intraoperative hearing function can be estimated by the latency of wave I. Hearing loss due to stretching of the brainstem can be estimated by the latency of wave III, and wave V is an early indicator of intraoperative hearing loss. Waves I and III remained stable both pre- and postoperatively, whereas wave V was unstable despite no surgery. Therefore, a precise operation and well-defined operative steps for surgeons during CPA surgery could facilitate maximal preservation of the anatomical structure and function.
Collapse
Affiliation(s)
- Yi Zhang
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Enhui Zhou
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Xiaocheng Xue
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Xiaoping Chen
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| |
Collapse
|
2
|
Joo BE, Kim JS, Deletis V, Park KS. Advances in Intraoperative Neurophysiology During Microvascular Decompression Surgery for Hemifacial Spasm. J Clin Neurol 2022; 18:410-420. [PMID: 35796266 PMCID: PMC9262452 DOI: 10.3988/jcn.2022.18.4.410] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/03/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Microvascular decompression (MVD) is a widely used surgical intervention to relieve the abnormal compression of a facial nerve caused by an artery or vein that results in hemifacial spasm (HFS). Various intraoperative neurophysiologic monitoring (ION) and mapping methodologies have been used since the 1980s, including brainstem auditory evoked potentials, lateral-spread responses, Z-L responses, facial corticobulbar motor evoked potentials, and blink reflexes. These methods have been applied to detect neuronal damage, to optimize the successful decompression of a facial nerve, to predict clinical outcomes, and to identify changes in the excitability of a facial nerve and its nucleus during MVD. This has resulted in multiple studies continuously investigating the clinical application of ION during MVD in patients with HFS. In this study we aimed to review the specific advances in methodologies and clinical research related to ION techniques used in MVD surgery for HFS over the last decade. These advances have enabled clinicians to improve the efficacy and surgical outcomes of MVD, and they provide deeper insight into the pathophysiology of the disease.
Collapse
Affiliation(s)
- Byung-Euk Joo
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Vedran Deletis
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia and Albert Einstein College of Medicine, New York, NY, USA
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| |
Collapse
|
3
|
Park SK, Joo BE, Kwon J, Kim M, Lee S, Lee JA, Park K. A prewarning sign for hearing loss by brainstem auditory evoked potentials during microvascular decompression surgery for hemifacial spasm. Clin Neurophysiol 2020; 132:358-364. [PMID: 33450558 DOI: 10.1016/j.clinph.2020.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/11/2020] [Accepted: 10/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to define the prewarning sign of brainstem auditory evoked potentials (BAEPs) associated with cerebellar retraction (CR) during microvascular decompression surgery for hemifacial spasm. METHODS A total of 241 patients with a latency prolongation of 1 ms or an amplitude decrement of 50% of wave V were analyzed. According to BAEPs before significant changes during CR, patients were classified into Groups A (latency prolongation of wave I [≥0.5 ms] without prolongation of the I-III interpeak interval [<0.5 ms]) and B (no latency prolongation of wave I [<0.5 ms] with prolongation of the I-III interpeak interval [≥0.5 ms]). BAEPs and postoperative hearing loss (HL) were compared between the two groups. RESULTS Group B comprised 160 (66.4%) patients. With maximal changes in wave V, latency prolongation (≥1 ms) with amplitude decrement (≥50%) was more common in Group B (p < 0.018). At the end of the operation, wave V loss was observed in 11 patients, including 10 patients from Group B. Five patients developed postoperative HL; all were from Group B. CONCLUSIONS Latency prolongation of wave III during CR was associated with serious BAEPs changes and postoperative HL. SIGNIFICANCE Latency prolongation of wave III is a significant prewarning sign.
Collapse
Affiliation(s)
- Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Byung-Euk Joo
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - John Kwon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Minsoo Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Jeong-A Lee
- Department of Nursing, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea; Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
4
|
Li N, Zhao WG, Pu CH, Yang WL. Quantitative study of the correlation between cerebellar retraction factors and hearing loss following microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 2018; 160:145-150. [PMID: 29075904 DOI: 10.1007/s00701-017-3368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND This prospective study quantitatively measured the cerebellar retraction factors, including retraction distance, depth and duration, and evaluated their potential relationship to the development of hearing loss after microvascular decompression (MVD) for hemifacial spasm (HFS). METHODS One hundred ten patients with primary HFS who underwent MVD in our department were included into this study. The cerebellar retraction factors were quantitatively measured on preoperative MR and timed during MVD. Associations of cerebellar retraction and other factors to postoperative hearing loss were analyzed. RESULTS Eleven (10%) patients developed hearing loss after MVD. Compared with the group without hearing loss, the cerebellar retraction distance, depth and duration of the group with hearing loss were significantly greater (p < 0.05). Multivariate regression analysis showed that greater cerebellar retraction depth and longer retraction duration were significantly associated with a higher incidence of postoperative hearing impairment (p < 0.05). CONCLUSION This study strongly suggested a correlation between the cerebellar retraction factors, especially retraction depth and duration, and possibility of hearing loss following MVD for HFS.
Collapse
|
5
|
Bartindale M, Kircher M, Adams W, Balasubramanian N, Liles J, Bell J, Leonetti J. Hearing Loss following Posterior Fossa Microvascular Decompression: A Systematic Review. Otolaryngol Head Neck Surg 2018; 158:62-75. [PMID: 28895459 PMCID: PMC7147641 DOI: 10.1177/0194599817728878] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022]
Abstract
Objectives (1) Determine the prevalence of hearing loss following microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS). (2) Demonstrate factors that affect postoperative hearing outcomes after MVD. Data Sources PubMed-NCBI, Scopus, CINAHL, and PsycINFO databases from 1981 to 2016. Review Methods Systematic review of prospective cohort studies and retrospective reviews in which any type of hearing loss was recorded after MVD for TN or HFS. Three researchers extracted data regarding operative indications, procedures performed, and diagnostic tests employed. Discrepancies were resolved by mutual consensus. Results Sixty-nine references with 18,233 operations met inclusion criteria. There were 7093 patients treated for TN and 11,140 for HFS. The overall reported prevalence of hearing loss after MVD for TN and HFS was 5.58% and 8.25%, respectively. However, many of these studies relied on subjective measures of reporting hearing loss. In 23 studies with consistent perioperative audiograms, prevalence of hearing loss was 13.47% for TN and 13.39% for HFS, with no significant difference between indications ( P = .95). Studies using intraoperative brainstem auditory evoked potential monitoring were more likely to report hearing loss for TN (relative risk [RR], 2.28; P < .001) but not with HFS (RR, 0.88; P = .056). Conclusion Conductive and sensorineural hearing loss are important complications following posterior fossa MVD. Many studies have reported on hearing loss using either subjective measures and/or inconsistent audiometric testing. Routine perioperative audiogram protocols improve the detection of hearing loss and may more accurately represent the true risk of hearing loss after MVD for TN and HFS.
Collapse
Affiliation(s)
- Matthew Bartindale
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Matthew Kircher
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - William Adams
- Clinical Research Office—Division of Biostatistics, Loyola University Medical Center, Maywood, Illinois, USA
| | - Neelam Balasubramanian
- Clinical Research Office—Division of Biostatistics, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jeffrey Liles
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jason Bell
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - John Leonetti
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| |
Collapse
|
6
|
Correlation Between Cerebellar Retraction and Hearing Loss After Microvascular Decompression for Hemifacial Spasm: A Prospective Study. World Neurosurg 2017; 102:97-101. [PMID: 28286281 DOI: 10.1016/j.wneu.2017.02.137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study prospectively investigated the relationship between cerebellar retraction factors measured on preoperative magnetic resonance and the development of postoperative hearing loss and evaluated their potential role in predicting the possibility of hearing loss after microvascular decompression (MVD) for hemifacial spasm (HFS). METHODS The study included 110 patients clinically diagnosed with primary HFS who underwent MVD in our department. The cerebellar retraction factors were quantitatively measured on preoperative magnetic resonance. Associations of cerebellar retraction and other risk factors with postoperative hearing loss were analyzed. RESULTS Eleven patients (10%) developed nonserviceable hearing loss after MVD. Compared with the group without hearing loss, the cerebellar retraction distance and depth of the group with hearing loss were significantly greater (P < 0.05). Multivariate logistic regression analysis showed that greater cerebellar retraction depth was significantly associated with the higher incidence of postoperative hearing loss (P < 0.05). CONCLUSIONS The results in this study strongly suggested the correlation between the cerebellar retraction depth and the possibility of hearing loss after MVD for HFS. In addition, cerebellar retraction depth could be considered as a useful tool to predict the risk of post-MVD hearing loss.
Collapse
|
7
|
Lee MH, Lee HS, Jee TK, Jo KI, Kong DS, Lee JA, Park K. Cerebellar retraction and hearing loss after microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 2015; 157:337-43. [PMID: 25514867 DOI: 10.1007/s00701-014-2301-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND This retrospective study evaluated the length of cerebellar retraction and the changes of intraoperative brainstem auditory evoked potential (BAEP) during microvascular decompression (MVD), and assessed the predictive value of the hearing loss as a prognostic indicator for the treatment outcome of hemifacial spasm (HFS). METHODS This series included 1,518 consecutive patients affected with HFS who underwent MVD, during which BAEP was monitored. Patients were divided into two groups based on whether hearing loss occurred following decompression or not. Each patient underwent a similar procedure performed by one neurosurgeon. The two patients groups were matched with regard to sex, age, and degree of spasm. RESULTS Among the 1,518 patients, 106 (6.98 %) displayed functional hearing changes. Hearing loss was permanent in 12 patients (0.79 %). Of the 1,412 patients with stationary hearing compared with preoperative audiometry, 96 patients were selected who were individually matched with respect to sex, age, and degree of spasm. BAEP changed immediately after cerebellar retraction in 7 of 12 hearing-loss patients, suggesting the importance of retraction on hearing outcomes. The distance from the cerebellar surface of the petrous temporal bone to the neurovascular compression point was measured. The median distance of cerebellar retraction in the hearing-loss group was 13.77 mm, which was longer than the median distance in the control group. CONCLUSIONS Preoperative measurement of the cerebellar retraction distance can be a valuable clue to predict and prevent postoperative hearing loss in MVD for HFS.
Collapse
|
8
|
Neurophysiologic Intraoperative Monitoring of the Vestibulocochlear Nerve. J Clin Neurophysiol 2011; 28:566-81. [DOI: 10.1097/wnp.0b013e31823da494] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
9
|
Brown DJ, Patuzzi RB. Evidence that the compound action potential (CAP) from the auditory nerve is a stationary potential generated across dura mater. Hear Res 2010; 267:12-26. [PMID: 20430085 DOI: 10.1016/j.heares.2010.03.091] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 03/17/2010] [Accepted: 03/22/2010] [Indexed: 11/25/2022]
Abstract
We have investigated the generation of the compound action potential (CAP) from the auditory nerve of guinea pigs. Responses to acoustic tone-bursts were recorded from the round window (RW), throughout the cochlear fluids, from the surface of the cochlear nucleus, from the central end of the auditory nerve after removal of the cochlear nucleus, from the scalp vertex, and from the contralateral ear. Responses were compared before, during and after experimental manipulations including pharmacological blockade of the auditory nerve, section of the auditory nerve, section of the efferent nerves, removal of the cochlear nucleus, and focal cooling of the cochlear nerve and/or cochlear nucleus. Regardless of the waveform changes occurring with these manipulations, the responses were similar in waveform but inverted polarity across the internal auditory meatus. The CAP waveforms were very similar before and after removal of the cochlear nucleus, apart from transient changes that could last many minutes. This suggests that the main CAP components are generated entirely by the eighth nerve. Based on previous studies and a clear understanding of the generation of extracellular potentials, we suggest that the early components in the responses recorded from the round window, from the cochlear fluids, from the surface of the cochlear nucleus, or from the scalp are a far-field or stationary potential, generated when the circulating action currents associated with each auditory neurone encounters a high extracellular resistance as it passes through the dura mater.
Collapse
Affiliation(s)
- Daniel J Brown
- The Brain and Mind Research Institute, Sydney Medical School, The University of Sydney, 100 Mallett Street, Camperdown 2050, Australia.
| | | |
Collapse
|
10
|
Ferroli P, Fioravanti A, Schiariti M, Tringali G, Franzini A, Calbucci F, Broggi G. Microvascular decompression for glossopharyngeal neuralgia: a long-term retrospectic review of the Milan-Bologna experience in 31 consecutive cases. Acta Neurochir (Wien) 2009; 151:1245-50. [PMID: 19513582 DOI: 10.1007/s00701-009-0330-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 03/31/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine surgical findings and results of microvascular decompression (MVD) for glossopharyngeal neuralgia (GN). METHODS Between 1990 and 2007, 31 consecutive patients affected by drug-resistant GN underwent MVD through a retromastoid keyhole in the supine position with the head rotated to the opposite side. A retrospective analysis was performed that paid particular attention to the relationship among surgical technique, pain control and side effects. RESULTS A vascular compression of the glossopharyngeal nerve was found in all cases. Twenty-eight out of 31 patients (90.3%) were found to be pain free without medication at long-term follow-up (1-17 years, mean 7.5 years). Three patients (9.7%) were found to require medication to control pain paroxysms that were less frequent and less severe than those observed preoperatively. Two patients required repeated surgery for a drug-resistant recurrence of pain for a total of 33 MVDs. We observed no mortality and did not find any long-term surgical morbidity. Cranial nerve impairment, when observed, always resolved in the following months. CONCLUSIONS MVD is a safe and effective treatment for GN in patients of all ages.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cranial Fossa, Posterior/anatomy & histology
- Cranial Fossa, Posterior/surgery
- Craniotomy/methods
- Craniotomy/mortality
- Craniotomy/statistics & numerical data
- Decompression, Surgical/methods
- Decompression, Surgical/mortality
- Decompression, Surgical/statistics & numerical data
- Female
- Glossopharyngeal Nerve/pathology
- Glossopharyngeal Nerve/physiopathology
- Glossopharyngeal Nerve/surgery
- Glossopharyngeal Nerve Diseases/pathology
- Glossopharyngeal Nerve Diseases/physiopathology
- Glossopharyngeal Nerve Diseases/surgery
- Humans
- Italy
- Male
- Mastoid/anatomy & histology
- Mastoid/surgery
- Medulla Oblongata/blood supply
- Medulla Oblongata/physiopathology
- Medulla Oblongata/surgery
- Microsurgery/methods
- Microsurgery/mortality
- Microsurgery/statistics & numerical data
- Middle Aged
- Minimally Invasive Surgical Procedures/methods
- Minimally Invasive Surgical Procedures/mortality
- Pain, Intractable/epidemiology
- Pain, Intractable/surgery
- Pain, Postoperative/epidemiology
- Pain, Postoperative/prevention & control
- Recurrence
- Retrospective Studies
- Time
- Time Factors
- Treatment Outcome
- Vascular Surgical Procedures/methods
- Vascular Surgical Procedures/mortality
- Vascular Surgical Procedures/statistics & numerical data
- Vertebral Artery/pathology
- Vertebral Artery/physiopathology
- Vertebral Artery/surgery
Collapse
Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy.
| | | | | | | | | | | | | |
Collapse
|