Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 5/2011

01-05-2011 | Clinical Article

Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery

Authors: Midori Amano, Michihiro Kohno, Osamu Nagata, Makoto Taniguchi, Shigeo Sora, Hiroaki Sato

Published in: Acta Neurochirurgica | Issue 5/2011

Login to get access

Abstract

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.
Literature
1.
Colletti V, Fiorino F, Policante Z, Bruni L (1997) Intraoperative monitoring of facial nerve antidromic potentials during acoustic neuroma surgery. Acta Otolaryngol 117:663–669PubMedCrossRef
2.
Colletti V, Fiorino FG (1998) Advances in monitoring of seventh and eighth cranial nerve function during posterior fossa surgery. Am J Otol 19:503–512PubMed
3.
Dong CC, Macdonald DB, Akagami R, Westerberg B, Alkhani A, Kanaan I, Hassounah M (2005) Intraoperative facial motor evoked potential monitoring with transcranial electrical stimulation during skull base surgery. Clin Neurophysiol 116:588–596PubMedCrossRef
4.
Grayeli AB, Guindi S, Kalamarides M, El Garem H, Smail M, Rey A, Sterkers O (2005) Four-channel electromyography of the facial nerve in vestibular schwannoma surgery: sensitivity and prognostic value for short-term facial function outcome. Otol Neurotol 26:114–120PubMedCrossRef
5.
Harner SG, Daube JR, Ebersold MJ, Beatty CW (1987) Improved preservation of facial nerve function with use of electrical monitoring during removal of acoustic neuromas. Mayo Clin Proc 62:92–102PubMed
6.
House JW, Brackmann (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–150PubMed
7.
Jellinek DA, Tan LC, Symon L (1991) The impact of continuous electrophysiological monitoring on preservation of the facial nerve during acoustic tumour surgery. Br J Neurosurg 5:19–24PubMedCrossRef
8.
Kombos T, Suess O, Kern BC, Funk T, Pietilä T, Brock M (2000) Can continuous intraoperative facial electromyography predict facial nerve function following cerebellopontine angle surgery? Neurol Med Chir (Tokyo) 40:501–507CrossRef
9.
Koos WT, Day JD, Matula C, Levy DI (1998) Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 88:506–512PubMedCrossRef
10.
Lin CM, Hsu JC, Wu RS, Wu KC, Yu CL, Wu HF, Tan PP (1997) Evoked facial nerve EMG and brainstem auditory evoked potential monitoring in cerebellopontine angle tumor resection. Acta Anaesthesiol Sin 5:141–147
11.
Liu BY, Tian YJ, Liu W, Liu SL, Qiao H, Zhang JT, Jia GJ (2007) Intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation for preservation of facial nerve function in patients with large acoustic neuroma. Chin Med J (Engl) 20:323–325
12.
Mandpe AH, Mikulec JRK, Pitts LH (1998) Comparison of response amplitude versus stimulation threshold in predicting early postoperative facial nerve fanction. Am J Otol 19:112–117PubMed
13.
Nakao Y, Piccirillo E, Falcioni M, Taibah A, Russo A, Kobayashi T, Sanna M (2002) Prediction of facial nerve outcome using electromyographic responses in acoustic neuroma surgery. Otol Neurotol 23:93–95PubMedCrossRef
14.
Neff BA, Ting J, Dickinson SL, Welling DB (2005) Facial nerve monitoring parameters as a predictor of postoperative facial nerve outcomes after vestibular schwannoma resection. Otol Neurotol 26:728–732PubMedCrossRef
15.
Prass RL, Lüders H (1986) Acoustic (loudspeaker) facial electromyographic monitoring: Part 1. Evoked electromyographic activity during acoustic neuroma resection. Neurosurgery 19:392–400PubMedCrossRef
16.
Romstöck J, Strauss C, Fahlbusch R (2000) Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery. J Neurosurg 93:586–593PubMedCrossRef
17.
Silverstein H, Willcox TO Jr, Rosenberg SI, Seidman MD (1994) Prediction of facial nerve function following acoustic neurona resection using intraoperative facial nerve stimulation. Laryngoscope 104:539–544PubMedCrossRef
18.
Taniguchi M (1998) Intraoperative monitoring for facial nerve preservation during acoustic neurinoma removal. Rinsho Noha 40:553–558, Jpn
Metadata
Title
Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery
Authors
Midori Amano
Michihiro Kohno
Osamu Nagata
Makoto Taniguchi
Shigeo Sora
Hiroaki Sato
Publication date
01-05-2011
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 5/2011
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-010-0937-6

Other articles of this Issue 5/2011

Acta Neurochirurgica 5/2011 Go to the issue

Editorial

Cryoneurolysis for the treatment of lumbar zygoapophyseal joint pain

Letter to the editor

Cerebellar variant of posterior reversible encephalopathy syndrome (PRES) after coil embolization for the hemorrhagic dissecting aneurysm

Experimental research

Axonal regeneration effects of Wnt3a-secreting fibroblast transplantation in spinal cord-injured rats

Letter to the editor

Isolated facial palsy as a hallmark of CSF overdrainage in shunted intracranial arachnoid cyst

Clinical Article

Surgical intervention for severe head injury: ethical considerations when performing life-saving but non-restorative surgery

Case Report

Giant, thrombosed, sellar–suprasellar internal carotid artery aneurysm with persistent, primitive trigeminal artery causing hypopituitarism