1
|
Khan MM, Dutta A, Rajappa D, Mallik D, Baldoncini M, Rangel CC, Chaurasia B. Facial nerve electrical motor evoked potential in cerebellopontine angle tumors for its anatomical and functional preservation. Surg Neurol Int 2024; 15:182. [PMID: 38840594 PMCID: PMC11152508 DOI: 10.25259/sni_14_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024] Open
Abstract
Background Among the technical measures to preserve facial nerve (FN) function, intraoperative neuromonitoring has become mandatory and is constantly being scrutinized. Hence, to determine the efficacy of FN motor evoked potentials (FNMEPs) in predicting long-term motor FN function following cerebellopontine angle (CPA) tumor surgery, an analysis of cases was done. Methods In 37 patients who underwent CPA surgery, FNMEPs through corkscrew electrodes positioned at C5-C6 and C6-C5 (C is the central line of the brain as per 10-20 EEG electrode placement) were used to deliver short train stimuli and recorded from the orbicularis oculi, oris, and mentalis muscles. Results In 58 patients, triggered electromyography (EMG) was able to identify the FN during resection of tumor, but 8 out of these (4.64%) patients developed new facial weakness, whereas 3 out of 38 (1.11%) patients who had intact FN function MEP (decrement of FN target muscles - CMAPs amplitude peak to peak >50-60%), developed new facial weakness (House and Brackmann grade II to III). Conclusion The FNMEP has significant superiority over triggered EMG when tumor is giant and envelops the FN.
Collapse
Affiliation(s)
| | - Abinash Dutta
- Department of Neurosurgery, Sakra World Hospital, Bengaluru, Karnataka, India
| | - Deepak Rajappa
- Department of Neurosurgery, Sakra World Hospital, Bengaluru, Karnataka, India
| | - Dattatraya Mallik
- Department of Neurosurgery, Sakra World Hospital, Bengaluru, Karnataka, India
| | - Matias Baldoncini
- Department of Neurosurgery, San Fernando Hospital, San Fernando, Argentina
| | - Carlos Castillo Rangel
- Department of Neurosurgery, Institute de Seguridad y Servicios Sociales de los Trabajadores Del Estrado, Mexico City, Mexico
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic,Birgunj,Nepal
| |
Collapse
|
2
|
Li X, Liang J, Song G, Jiao H. Using a Facial Nerve Stimulator to Record the Auditory Nerve Compound Action Potential to Locate the Auditory Nerve During Vestibular Schwannoma Resection. World Neurosurg 2023; 175:e582-e592. [PMID: 37030482 DOI: 10.1016/j.wneu.2023.03.146] [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: 03/13/2023] [Accepted: 03/31/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Improved technology in vestibular neuroma resection and facial nerve protection has become more sophisticated, and the protection of hearing during vestibular schwannoma resection is crucial. Currently, brainstem auditory evoked potential (BAEP), cochlear electrography, and cochlear nerve compound action potential (CNAP) are frequently used. The CNAP waveform is stable; however, the recording electrode can easily affect the procedure and cannot map the auditory nerve. The purpose of the study was to explore a simple method to record the CNAP and map the auditory nerve. METHODS In this study, CNAP was recorded using a facial nerve bipolar stimulator to localize and protect the auditory nerve. The BAEP click stimulation mode was used. A bipolar stimulator was used as the recording electrode to record CNAP and locate anatomical displacement of the auditory nerve. The CNAP of 40 patients was monitored. Pure tone audiometry, speech discrimination score, and auditory evoked potential (BAEP) evaluations were performed on all patients before and after surgery. RESULTS Of the 40 patients, 30 patients obtained CNAP during surgery, and the rate of CNAP obtained was significantly higher than that of BAEP. The sensitivity and specificity of decrease in CNAP in predicting significant hearing loss were 88.9% and 66.7%, respectively. The sensitivity and specificity of the disappearance of CNAP in predicting significant hearing loss were 52.9% and 92.3%, respectively. CONCLUSIONS The bipolar facial nerve stimulator can locate and protect the auditory nerve by recording a stable potential. The CNAP obtained rate was significantly higher than that of BAEP. The disappearance of BAEP during acoustic neuroma monitoring can be used as a standard alert for the surgeon, and decrease in CNAP is an alert for the operator.
Collapse
Affiliation(s)
- Xiaoyu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China.
| | - Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Hanyi Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| |
Collapse
|
3
|
Rampp S, Holze M, Scheller C, Strauss C, Prell J. Neural networks for estimation of facial palsy after vestibular schwannoma surgery. J Clin Monit Comput 2023; 37:575-583. [PMID: 36333576 PMCID: PMC10068649 DOI: 10.1007/s10877-022-00928-9] [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: 05/03/2022] [Revised: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Facial nerve damage in vestibular schwannoma surgery is associated with A-train patterns in free-running EMG, correlating with the degree of postoperative facial palsy. However, anatomy, preoperative functional status, tumor size and occurrence of A-trains clusters, i.e., sudden A-trains in most channels may further contribute. In the presented study, we examine neural networks to estimate postoperative facial function based on such features. METHODS Data from 200 consecutive patients were used to train neural feed-forward networks (NN). Estimated and clinical postoperative House and Brackmann (HB) grades were compared. Different input sets were evaluated. RESULTS Networks based on traintime, preoperative HB grade and tumor size achieved good estimation of postoperative HB grades (chi2 = 54.8), compared to using tumor size or mean traintime alone (chi2 = 30.6 and 31.9). Separate intermediate nerve or detection of A-train clusters did not improve performance. Removal of A-train cluster traintime improved results (chi2 = 54.8 vs. 51.3) in patients without separate intermediate nerve. CONCLUSION NN based on preoperative HB, traintime and tumor size provide good estimations of postoperative HB. The method is amenable to real-time implementation and supports integration of information from different sources. NN could enable multimodal facial nerve monitoring and improve postoperative outcomes.
Collapse
Affiliation(s)
- Stefan Rampp
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube Str. 40, 06120, Halle, Germany.
- Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Magdalena Holze
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube Str. 40, 06120, Halle, Germany
| | - Christian Scheller
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube Str. 40, 06120, Halle, Germany
| | - Christian Strauss
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube Str. 40, 06120, Halle, Germany
| | - Julian Prell
- Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube Str. 40, 06120, Halle, Germany
| |
Collapse
|
4
|
Roman A, Tufegdzic B, Lamperti M, Pinto V, Roser F. Before the Knife: A Detailed Step-by-Step Description of an Optimized Semi-Sitting Position in Posterior Fossa Surgery. World Neurosurg 2023; 172:e241-e249. [PMID: 36608791 DOI: 10.1016/j.wneu.2022.12.137] [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: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND In an ample armamentarium in neurosurgery, the semi-sitting position has produced debate regarding its benefits and risks. Although the position is apparently intuitive, many have abandoned its use since its initial inception, because of reported complexity and potential complications, leading to impracticality. However, through standardization, it has been shown not only to be safe but to carry with it many advantages, including less risk of secondary neurovascular injuries and better visualization of the surgical field. As with any surgical technical nuance, the semi-sitting position has advantages and disadvantages that must be weighed before the decision is made to adopt it or not, not only in a case-by-case scenario but also from a departmental standpoint. As we attempt to show, the advantages from a standardized approach for the semi-sitting position in experienced institutions may be more than sufficient to significantly outweigh the disadvantages, making it the preferable option for most, although not all, posterior fossa surgical interventions. METHODS In the present study, we aim to elaborate a straightforward narrative of the steps before incision, in an attempt to simplify the complexity of the position, alleviating its disadvantages and exponentially concentrating on its benefits. In nearly 100 steps, we carefully describe the points that culminate with the skin incision, initiating the intraoperative part of the procedure. Each step, therefore, is detailed in full, not in an effort to create a strict manual of the semi-sitting position but rather to facilitate understanding and put the technique into effect in a real-life scenario, thus simplifying what some depict as complex and time consuming. CONCLUSIONS Although several of the steps described are also relevant and integral parts of other surgical positioning, we intend to create a protocol, in a stepwise fashion, to allow facilitated following, to be easily implemented in departments with different levels of experience. The steps comprise nursing care through to electrophysiologic and anesthesiologic approaches, along with neurosurgical cooperation, making it a team approach, not only to avoid position-related complications but also to optimize preoperative standardization, constructing a safe, efficient, and patient-centered scenario, to set the best possible stage for the next step: the intraoperative part of the intervention.
Collapse
Affiliation(s)
- Alex Roman
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Boris Tufegdzic
- Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Massimo Lamperti
- Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Vania Pinto
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Florian Roser
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
| |
Collapse
|
5
|
Li X, Bao Y, Liang J, Chen G, Guo H, Li M. Electrophysiological mapping and assessment of facial nerve functioning during acoustic neuroma operations. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:405. [PMID: 33842626 PMCID: PMC8033303 DOI: 10.21037/atm-20-6858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Electrophysiological monitoring is used routinely to protect the facial nerve during acoustic neuroma surgery. This study aimed to clarify the relationship between the facial nerve’s electrophysiological monitoring parameters and its function after surgery. Methods Fifty-two patients with acoustic neuroma who underwent surgery were included. After localizing the facial nerve, its monitoring results during surgeries performed at our center were analyzed. Postoperative nerve functioning was correlated with the stimulation threshold of the facial nerve’s proximal segment, proximal-to-distal amplitude ratio of the facial nerve, and proximal stimulation amplitude. Receiver-operating characteristic curves of the three parameters were calculated. Results Electrical stimulation accurately described the facial nerve’s anatomic distribution after the depth of anesthesia was assessed via accessory nerve stimulation. The data recorded after resection showed that a higher proximal-to-distal amplitude ratio was associated with better facial nerve functioning (P=0.037). A lower stimulation threshold of the proximal segment correlated with better facial nerve functioning (P=0.038). Conclusions The most sensitive index to predict postoperative nerve functioning is the facial nerve’s proximal-to-distal amplitude ratio. Accessory nerve stimulation can determine the appropriate depth of anesthesia, Electromyography (EMG) monitoring of the facial nerve during acoustic neuroma surgery can protect it effectively.
Collapse
Affiliation(s)
- Xiaoyu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Hongchuan Guo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| |
Collapse
|