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

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 11/2015

01-11-2015 | Clinical Article - Brain Tumors

Predictive value of intraoperative neurophysiologic monitoring in assessing long-term facial function in grade IV vestibular schwannoma removal

Authors: Sérgio Duarte-Costa, Rui Vaz, Débora Pinto, Fernando Silveira, António Cerejo

Published in: Acta Neurochirurgica | Issue 11/2015

Login to get access

Abstract

Background

Despite routine use of intraoperative neuromonitoring in acoustic neuroma removal, its application in predicting long-term facial function is limited.

Methods

Prospective recording of facial nerve function and subsequent review of intraoperative neurophysiologic data. Stimulation of the facial nerve was performed proximal and distal to the tumor locus after tumor removal with measurement of amplitude and latency responses in the orbicularis oculi and oris muscles. Prospective review of current facial nerve function was performed using the House–Brackmann (HB) scoring system. Good facial function was determined as HB I/II and HB III–VI was considered poor facial function. Minimum follow-up time was 15 months, and averaged 40 months.

Results

Twenty-four grade IV acoustic neuromas (54 % larger than 4 cm) were completely removed from October 2008 to November 2013. Nine patients (37.5 %) had HB I/II and 15 (62.5 %) had HB III–VI. The poor prognosis group had a higher latency than the good prognosis group (p = 0.045). Lower proximal amplitude was detected in the poor prognosis group (p = 0.046). Lower proximal-to-distal amplitude ratio was also detected in the poor prognosis group (p = 0.052). Amplitude ratio cut-offs of 0.44 and 0.25 were able to predict poor prognosis with sensitivity of 0.73 and 0.4 and specificity of 0.78 and 1, respectively (p = 0.046).

Conclusions

Lower proximal amplitude and proximal-distal amplitude ratio were previously reported as predictors of poor facial function in different sizes of vestibular schwannomas. We observed that the same applies specifically for large-sized, completely removed, grade IV tumors. Additionally, we describe a difference in proximal latency time between the good and poor prognosis groups, which was not previously reported.
Literature
1.
Acioly MA, Liebsch M, de Aguiar PH, Tatagiba M (2013) Facial nerve monitoring during cerebellopontine angle and skull base tumor surgery: a systematic review from description to current success on function prediction. World Neurosurg 80:e271–e300CrossRefPubMed
2.
Arnoldner C, Mick P, Pirouzmand F, Houlden D, Lin VY, Nedzelski JM, Chen JM (2013) Facial nerve prognostication in vestibular schwannoma surgery: the concept of percent maximum and its predictability. Laryngoscope 123:2533–2538PubMed
3.
Axon PR, Ramsden RT (1999) Intraoperative electromyography for predicting facial function in vestibular schwannoma surgery. Laryngoscope 109:922–926CrossRefPubMed
4.
Bernat I, Grayeli AB, Esquia G, Zhang Z, Kalamarides M, Sterkers O (2010) Intraoperative electromyography and surgical observations as predictive factors of facial nerve outcome in vestibular schwannoma surgery. Otol Neurotol 31:306–312CrossRefPubMed
5.
Bozorg Grayeli A, Kalamarides M, Fraysse B, Deguine O, Favre G, Martin C, Mom T, Sterkers O (2005) Comparison between intraoperative observations and electromyographic monitoring data for facial nerve outcome after vestibular schwannoma surgery. Acta Otolaryngol 125:1069–1074CrossRefPubMed
6.
Darrouzet V, Martel J, Enee V, Bebear JP, Guerin J (2004) Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope 114:681–688CrossRefPubMed
7.
Harner SG, Daube JR, Beatty CW, Ebersold MJ (1988) Intraoperative monitoring of the facial nerve. Laryngoscope 98:209–212CrossRefPubMed
8.
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 62:92–102CrossRefPubMed
9.
Hone SW, Commins DJ, Rames P, Chen JM, Rowed D, McLean A, Nedzelski JM (1997) Prognostic factors in intraoperative facial nerve monitoring for acoustic neuroma. J Otolaryngol 26:374–378PubMed
10.
House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147PubMed
11.
Isaacson B, Kileny PR, El-Kashlan HK (2005) Prediction of long-term facial nerve outcomes with intraoperative nerve monitoring. Otol Neurotol 26:270–273CrossRefPubMed
12.
Kombos T, Suess O, Kern BC, Funk T, Pietila T, Brock M (2000) Can continuous intraoperative facial electromyography predict facial nerve function following cerebellopontine angle surgery? Neurol Med Chir (Tokyo) 40:501–505, discussion 506–507 CrossRef
13.
Koos WT, Day JD, Matula C, Levy DI (1998) Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 88:506–512CrossRefPubMed
14.
Koos WT, Spetzler RF, Lang J (1993) Color Atlas of Microneurosurgery, ed2
15.
Lownie SP, Drake CG (1991) Radical intracapsular removal of acoustic neurinomas. Long-term follow-up review of 11 patients. J Neurosurg 74:422–425CrossRefPubMed
16.
Lye RH, Dutton J, Ramsden RT, Occleshaw JV, Ferguson IT, Taylor I (1982) Facial nerve preservation during surgery for removal of acoustic nerve tumors. J Neurosurg 57:739–746CrossRefPubMed
17.
McClelland S 3rd, Guo H, Okuyemi KS (2011) Morbidity and mortality following acoustic neuroma excision in the United States: analysis of racial disparities during a decade in the radiosurgery era. Neuro Oncol 13:1252–1259PubMedCentralCrossRefPubMed
18.
Moffat DA, Parker RA, Hardy DG, Macfarlane R (2014) Factors affecting final facial nerve outcome following vestibular schwannoma surgery. J Laryngol Otol 128:406–415CrossRefPubMed
19.
Morton RP, Ackerman PD, Pisansky MT, Krezalek M, Leonetti JP, Raffin MJ, Anderson DE (2011) Prognostic factors for the incidence and recovery of delayed facial nerve palsy after vestibular schwannoma resection. J Neurosurg 114:375–380CrossRefPubMed
20.
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 26:728–732CrossRefPubMed
21.
Niparko JK, Kileny PR, Kemink JL, Lee HM, Graham MD (1989) Neurophysiologic intraoperative monitoring: II. Facial nerve function. Am J Otol 10:55–61CrossRefPubMed
22.
Nissen AJ, Sikand A, Curto FS, Welsh JE, Gardi J (1997) Value of intraoperative threshold stimulus in predicting postoperative facial nerve function after acoustic tumor resection. Am J Otol 18:249–251PubMed
23.
Prell J, Rampp S, Romstock J, Fahlbusch R, Strauss C (2007) Train time as a quantitative electromyographic parameter for facial nerve function in patients undergoing surgery for vestibular schwannoma. J Neurosurg 106:826–832CrossRefPubMed
24.
Prell J, Strauss C, Rachinger J, Alfieri A, Scheller C, Herfurth K, Rampp S (2014) Facial nerve palsy after vestibular schwannoma surgery: dynamic risk-stratification based on continuous EMG-monitoring. Clin Neurophysiol 125:415–421CrossRefPubMed
25.
Rinaldi V, Casale M, Bressi F, Potena M, Vesperini E, De Franco A, Silvestri S, Zini C, Salvinelli F (2012) Facial nerve outcome after vestibular schwannoma surgery: our experience. J Neurol Surg B Skull Base 73:21–27PubMedCentralCrossRefPubMed
26.
Roland JT Jr, Fishman AJ, Golfinos JG, Cohen N, Alexiades G, Jackman AH (2004) Cranial nerve preservation in surgery for large acoustic neuromas. Skull Base 14:85–90, discussion 90–81 PubMedCentralCrossRefPubMed
27.
Romstock J, Strauss C, Fahlbusch R (2000) Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery. J Neurosurg 93:586–593CrossRefPubMed
28.
Ryzenman JM, Pensak ML, Tew JM Jr (2004) Patient perception of comorbid conditions after acoustic neuroma management: survey results from the acoustic neuroma association. Laryngoscope 114:814–820CrossRefPubMed
29.
Samii M, Gerganov VM, Samii A (2010) Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg 112:860–867CrossRefPubMed
30.
Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40:11–21, discussion 21–13 PubMed
31.
Schmitt WR, Daube JR, Carlson ML, Mandrekar JN, Beatty CW, Neff BA, Driscoll CL, Link MJ (2013) Use of supramaximal stimulation to predict facial nerve outcomes following vestibular schwannoma microsurgery: results from a decade of experience. J Neurosurg 118:206–212CrossRefPubMed
32.
Selesnick SH, Carew JF, Victor JD, Heise CW, Levine J (1996) Predictive value of facial nerve electrophysiologic stimulation thresholds in cerebellopontine-angle surgery. Laryngoscope 106:633–638CrossRefPubMed
33.
34.
Silva J, Cerejo A, Duarte F, Silveira F, Vaz R (2012) Surgical removal of giant acoustic neuromas. World Neurosurg 77:731–735CrossRefPubMed
35.
Sobottka SB, Schackert G, May SA, Wiegleb M, Reiss G (1998) Intraoperative facial nerve monitoring (IFNM) predicts facial nerve outcome after resection of vestibular schwannoma. Acta Neurochir (Wien) 140:235–242, discussion 242–233 CrossRef
36.
Strauss C, Romstock J, Fahlbusch R, Rampp S, Scheller C (2006) Preservation of facial nerve function after postoperative vasoactive treatment in vestibular schwannoma surgery. Neurosurgery 59:577–584, discussion 577–584 CrossRefPubMed
37.
Sughrue ME, Kaur R, Kane AJ, Rutkowski MJ, Kaur G, Yang I, Pitts LH, Parsa AT (2010) The value of intraoperative facial nerve electromyography in predicting facial nerve function after vestibular schwannoma surgery. J Clin Neurosci 17:849–852CrossRefPubMed
38.
Sughrue ME, Yang I, Rutkowski MJ, Aranda D, Parsa AT (2010) Preservation of facial nerve function after resection of vestibular schwannoma. Br J Neurosurg 24:666–671CrossRefPubMed
39.
Taha JM, Tew JM Jr, Keith RW (1995) Proximal-to-distal facial amplitude ratios as predictors of facial nerve function after acoustic neuroma excision. J Neurosurg 83:994–998CrossRefPubMed
40.
Talfer S, Dutertre G, Conessa C, Desgeorges M, Poncet JL (2010) Surgical treatment of large vestibular schwannomas (stages III and IV). Eur Ann Otorhinolaryngol Head Neck Dis 127:63–69CrossRefPubMed
41.
Tos M, Stangerup SE, Caye-Thomasen P, Tos T, Thomsen J (2004) What is the real incidence of vestibular schwannoma? Arch Otolaryngol Head Neck Surg 130:216–220CrossRefPubMed
42.
Turel MK, Babu KS, Singh G, Chacko AG (2014) The utility of facial nerve amplitude and latency ratios in predicting postoperative facial nerve function after vestibular schwannoma surgery. Neurol India 62:178–182CrossRefPubMed
43.
Yetiser S, Karapinar U (2007) Hypoglossal-facial nerve anastomosis: a meta-analytic study. Ann Otol Rhinol Laryngol 116:542–549CrossRefPubMed
44.
Yingling CD, Gardi JN (1992) Intraoperative monitoring of facial and cochlear nerves during acoustic neuroma surgery. Otolaryngol Clin North Am 25:413–448PubMed
45.
Yokoyama T, Uemura K, Ryu H (1991) Facial nerve monitoring by monopolar low constant current stimulation during acoustic neurinoma surgery. Surg Neurol 36:12–18CrossRefPubMed
46.
Youssef AS, Downes AE (2009) Intraoperative neurophysiological monitoring in vestibular schwannoma surgery: advances and clinical implications. Neurosurg Focus 27, E9CrossRefPubMed
Metadata
Title
Predictive value of intraoperative neurophysiologic monitoring in assessing long-term facial function in grade IV vestibular schwannoma removal
Authors
Sérgio Duarte-Costa
Rui Vaz
Débora Pinto
Fernando Silveira
António Cerejo
Publication date
01-11-2015
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 11/2015
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-015-2571-9

Other articles of this Issue 11/2015

Acta Neurochirurgica 11/2015 Go to the issue

Technical Note - Neurosurgery Training

Training for brain tumour resection: a realistic model with easy accessibility

Technical Note - Neurosurgical Techniques

Optional real-time display of intraoperative neurophysiological monitoring in the microscopic field of view: avoiding communication failures in the operating room

Clinical Article - Spine

Vertebral artery injury during foraminal decompression in "low-risk" cervical spine surgery: incidence and management

Letter to the editor - Brain Injury

Life-threatening paradoxical brain herniation rapidly reversed by emergency cranioplasty repair: a case report

Letter to the editor - Vascular

Test occlusion under monitoring of motor-evoked potentials for a giant distal anterior cerebral artery aneurysm: letter to the editor

Case Report - Neurosurgical Techniques

Ultrasound evaluation in traumatic peripheral nerve lesions: from diagnosis to surgical planning and follow-up