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Open Access 01-12-2024 | Vestibular Schwannoma | Original Article

Predictive value of facial motor–evoked potential and electromyography for facial motor function in vestibular schwannoma surgery

Authors: Kathrin Machetanz, Martin Roegele, Marina Liebsch, Linda Oberle, Eliane Weinbrenner, Mykola Gorbachuk, Sophie S. Wang, Marcos Tatagiba, Georgios Naros

Published in: Acta Neurochirurgica | Issue 1/2024

Abstract

Purpose

Intraoperative neuromonitoring (IONM) aims to preserve facial nerve (FN) function during vestibular schwannoma (VS) surgery. However, current techniques such as facial nerve motor evoked potentials (FNMEP) or electromyography (fEMG) alone are limited in predicting postoperative facial palsy (FP). The objective of this study was to analyze a compound fEMG/FNMEP approach.

Methods

Intraoperative FNMEP amplitude and the occurrence of fEMG-based A-trains were prospectively determined for the orbicularis oris (ORI) and oculi (OCU) muscle in 322 VS patients. Sensitivity and specificity of techniques to predict postoperative FN function were calculated. Confounding factors as tumor size, volume of intracranial air, or IONM duration were analyzed.

Results

A relevant immediate postoperative FP was captured in 105/322 patients with a significant higher risk in large VS. While fEMG demonstrated a high sensitivity (77% and 86% immediately and 15 month postoperative, respectively) for identifying relevant FP, specificity was low. In contrast, FNMEP have a significantly higher specificity of 80.8% for predicting postoperative FP, whereas the sensitivity is low. A retrospective combination of techniques demonstrated still an incorrect prediction of FP in ~ 1/3 of patients.

Conclusions

FNMEP and fEMG differ in sensitivity and specificity to predict postoperative FP. Although a combination of IONM techniques during VS surgery may improve prediction of FN function, current techniques are still inaccurate. Further development is necessary to improve IONM approaches for FP prediction.

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Title: Predictive value of facial motor–evoked potential and electromyography for facial motor function in vestibular schwannoma surgery
Authors: Kathrin Machetanz
Martin Roegele
Marina Liebsch
Linda Oberle
Eliane Weinbrenner
Mykola Gorbachuk
Sophie S. Wang
Marcos Tatagiba
Georgios Naros
Publication date: 01-12-2024
Publisher: Springer Vienna
Keywords: Vestibular Schwannoma
Vestibular Schwannoma
Motor Evoked Potential
Motor Evoked Potential
Facial Palsy
Published in: Acta Neurochirurgica / Issue 1/2024
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-024-05927-0

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Springer Medicine

Predictive value of facial motor–evoked potential and electromyography for facial motor function in vestibular schwannoma surgery

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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