scholarly journals Prognostic value of transcranial facial nerve motor-evoked potentials in predicting facial nerve function following cerebellopontine angle tumorectomy

Medicine ◽  
2018 ◽  
Vol 97 (40) ◽  
pp. e12576 ◽  
Author(s):  
Hongmei Song ◽  
Chengyuan Ma ◽  
Dahai Xu ◽  
Mingxin Yu ◽  
Jiachun Feng ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Evoked Potentials ◽  
Cerebellopontine Angle ◽  
Prognostic Value ◽  
Motor Evoked Potentials ◽  
Nerve Function ◽  
Facial Nerve Function

scholarly journals Facial nerve motor evoked potentials during skull base surgery to monitor facial nerve function using the threshold-level method

2013 ◽  
Vol 34 (3) ◽  
pp. E7 ◽  
Author(s):  
Johannes Sarnthein ◽  
Nader Hejrati ◽  
Marian C. Neidert ◽  
Alexander M. Huber ◽  
Niklaus Krayenbühl
Keyword(s):  
At Risk ◽  
Facial Nerve ◽  
Evoked Potentials ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Motor Evoked Potentials ◽  
Threshold Level ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Level Method

Object During surgeries that put the facial nerve at risk for injury, its function can be continuously monitored by transcranial facial nerve motor evoked potentials (FNMEPs) in facial nerve target muscles. Despite their advantages, FNMEPs are not yet widely used. While most authors use a 50% reduction in FNMEP response amplitudes as a warning criterion, in this paper the authors' approach was to keep the response amplitude constant by increasing the stimulation intensity and to establish a warning criterion based on the “threshold-level” method. Methods The authors included 34 consecutive procedures involving 33 adult patients (median age 47 years) in whom FNMEPs were monitored. A threshold increase greater than 20 mA for eliciting FNMEPs in the most reliable facial nerve target muscle was considered a prediction of reduced postoperative facial nerve function, and subsequently a warning was issued to the surgeon. Preoperative and early postoperative function was documented using the House-Brackmann grading system. Results Monitoring of FNMEPs was feasible in all 34 surgeries in at least one facial nerve target muscle. The mentalis muscle yielded the best results. The House-Brackmann grade deteriorated in 17 (50%) of 34 cases. The warning criterion was reached in 18 (53%) of 34 cases, which predicted an 83% risk of House-Brackmann grade deterioration. Sensitivity amounted to 88% (CI 64%–99%) and specificity to 82% (CI 57%–96%). Deterioration of FNMEPs and a worse House-Brackmann grade showed a high degree of association (p < 0.001). The impact of FNMEP monitoring on surgical strategy is exemplified in an illustrative case. Conclusions In surgeries that put the facial nerve at risk, the intraoperative increase in FNMEP stimulation threshold was closely correlated to postoperative facial nerve dysfunction. Monitoring of FNMEPs is a valid indicator of facial nerve function in skull base surgery. It should be used as an adjunct to direct electrical facial nerve stimulation and continuous electromyographic monitoring of facial nerve target muscles.

Intraoperative facial motor evoked potential monitoring for pontine cavernous malformation resection

2020 ◽  
Vol 132 (1) ◽  
pp. 265-271
Author(s):  
Ridzky Firmansyah Hardian ◽  
Tetsuya Goto ◽  
Yu Fujii ◽  
Kohei Kanaya ◽  
Tetsuyoshi Horiuchi ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Cavernous Malformation ◽  
Motor Evoked Potentials ◽  
Motor Evoked Potential ◽  
Warning Signs ◽  
Constant Current ◽  
Karnofsky Performance Scale ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Cavernous Malformations

OBJECTIVEThe aim of this study was to predict postoperative facial nerve function during pontine cavernous malformation surgery by monitoring facial motor evoked potentials (FMEPs).METHODSFrom 2008 to 2017, 10 patients with pontine cavernous malformations underwent total resection via the trans–fourth ventricle floor approach with FMEP monitoring. House-Brackmann grades and Karnofsky Performance Scale (KPS) scores were obtained pre- and postoperatively. The surgeries were performed using one of 2 safe entry zones into the brainstem: the suprafacial triangle and infrafacial triangle approaches. Six patients underwent the suprafacial triangle approach, and 4 patients underwent the infrafacial triangle approach. A cranial peg screw electrode was used to deliver electrical stimulation for FMEP by a train of 4 or 5 pulse anodal constant current stimulation. FMEP was recorded from needle electrodes on the ipsilateral facial muscles and monitored throughout surgery by using a threshold-level stimulation method.RESULTSFMEPs were recorded and analyzed in 8 patients; they were not recorded in 2 patients who had severe preoperative facial palsy and underwent an infrafacial triangle approach. Warning signs appeared in all patients who underwent the suprafacial triangle approach. However, after temporarily stopping the procedures, FMEP findings during surgery showed recovery of the thresholds. FMEPs in patients who underwent the infrafacial triangle approach were stable during the surgery. House-Brackmann grades were unchanged postoperatively in all patients. Postoperative KPS scores improved in 3 patients, decreased in 1, and remained the same in 6 patients.CONCLUSIONSFMEPs can be used to monitor facial nerve function during surgery for pontine cavernous malformations, especially when the suprafacial triangle approach is performed.

scholarly journals Sensitivity and Negative Predictive Value of Motor Evoked Potentials of the Facial Nerve

2021 ◽  
Author(s):  
Nicolas Bovo ◽  
Shahan Momjian ◽  
Renato Gondar ◽  
Philippe Bijlenga ◽  
Karl Schaller ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Evoked Potentials ◽  
Negative Predictive Value ◽  
Patient Group ◽  
Vestibular Schwannoma ◽  
Predictive Value ◽  
Cerebellopontine Angle ◽  
Motor Evoked Potentials ◽  
Vestibular Schwannomas ◽  
Predictive Values

Abstract Objective The objective of this study was to determine the performance of the standard alarm criterion of motor evoked potentials (MEPs) of the facial nerve in surgeries performed for resections of vestibular schwannomas or of other lesions of the cerebellopontine angle. Methods This retrospective study included 33 patients (16 with vestibular schwannomas and 17 with other lesions) who underwent the resection surgery with transcranial MEPs of the facial nerve. A reproducible 50% decrease in MEP amplitude, resistant to a 10% increase in stimulation intensity, was applied as the alarm criterion during surgery. Facial muscular function was clinically evaluated with the House–Brackmann score (HBS), pre- and postsurgery at 3 months. Results In the patient group with vestibular schwannoma, postoperatively, the highest sensitivity and negative predictive values were found for a 30% decrease in MEP amplitude, that is, a criterion stricter than the 50% decrease in MEP amplitude criterion, prone to trigger more warnings, used intraoperatively. With this new criterion, the sensitivity would be 88.9% and the negative predictive value would be 85.7%. In the patient group with other lesions of the cerebellopontine angle, the highest sensitivity and negative predictive values were found equally for 50, 60, or 70% decrease in MEP amplitude. With these criteria, the sensitivities and the negative predictive values would be 100.0%. Conclusion Different alarm criteria were found for surgeries for vestibular schwannomas and for other lesions of the cerebellopontine angle. The study consolidates the stricter alarm criterion, that is, a criterion prone to trigger early warnings, as found previously by others for vestibular schwannoma surgeries (30% decrease in MEP amplitude).

scholarly journals Resection of a Dumbbell-Shaped Facial Nerve Schwannoma With Preservation of Facial Nerve Function Through the Extended Middle Fossa Approach: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Kaith K Almefty ◽  
Wenya Linda Bi ◽  
Walid Ibn Essayed ◽  
Ossama Al-Mefty
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Internal Auditory Canal ◽  
Growth Patterns ◽  
Geniculate Ganglion ◽  
Nerve Function ◽  
Middle Fossa ◽  
Facial Nerve Function ◽  
Large Tumor ◽  
Middle Fossa Approach

Abstract Facial nerve schwannomas are rare and can arise from any segment along the course of the facial nerve.1 Their location and growth patterns present as distinct groups that warrant specific surgical management and approaches.2 The management challenge arises when the facial nerve maintains good function (House-Brackmann grade I-II).3 Hence, a prime goal of management is to maintain good facial animation. In large tumors, however, resection with facial nerve function preservation should be sought and is achievable.4,5  While tumors originating from the geniculate ganglion grow extradural on the floor of the middle fossa, they may extend via an isthmus through the internal auditory canal to the cerebellopontine angle forming a dumbbell-shaped tumor. Despite the large size, they may present with good facial nerve function. These tumors may be resected through an extended middle fossa approach with preservation of facial and vestibulocochlear nerve function.  The patient is a 62-yr-old man who presented with mixed sensorineural and conductive hearing loss and normal facial nerve function. Magnetic resonance imaging (MRI) revealed a large tumor involving the middle fossa, internal auditory meatus, and cerebellopontine angle.  The tumor was resected through an extended middle fossa approach with a zygomatic osteotomy and anterior petrosectomy.6 A small residual was left at the geniculate ganglion to preserve facial function. The patient did well with hearing preservation and intact facial nerve function. He consented to the procedure and publication of images.  Image at 1:30 © Ossama Al-Mefty, used with permission. Images at 2:03 reprinted from Kadri and Al-Mefty,6 with permission from JNSPG.

Masseter-to-Facial Cranial Nerve Anastomosis: A Report of 30 Cases

2020 ◽  
Vol 19 (5) ◽  
pp. 502-509
Author(s):  
Alexander V Zotov ◽  
Jamil A Rzaev ◽  
Sergey V Chernov ◽  
Alexander B Dmitriev ◽  
Anton V Kalinovsky ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Postoperative Recovery ◽  
Facial Nerve Paralysis ◽  
Tumor Surgery ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Paralysis ◽  
Cerebellopontine Angle Tumor ◽  
Facial Reanimation

Abstract BACKGROUND Facial nerve paralysis (FP) is a possible complication of cerebellopontine angle tumor surgery. Several donor nerves have been used in the past for facial reanimation. We report the results of 30 cases of masseter-to-facial anastomosis. OBJECTIVE To prospectively evaluate the efficacy of V to VII anastomosis after FP. METHODS In a prospective study, we included 30 consecutive patients with FP (20 women and 10 men) whose mean age was 48.8 yr (32-76 yr). In almost all cases, FP developed after cerebellopontine angle tumor surgery (29 patients), whereas in one case, FP occurred after skull base trauma. Pre- and postoperative evaluation of facial nerve function was performed using the House-Brackmann (HB) scale and the Sokolovsky scale, as well as by electromyography. Follow-up ranged from 11 to 51 mo and averaged 22 mo. RESULTS All patients achieved functional recovery of the facial nerve from VI to either III or IV HB degree. Patients with short time FP showed significantly better postoperative recovery. CONCLUSION The results of the V to VII anastomosis demonstrate a significant improvement of facial nerve function and virtually no complications.

Preoperative and postoperative auditory and facial nerve function in cerebellopontine angle meningiomas

1995 ◽  
Vol 112 (2) ◽  
pp. 228-234 ◽  
Author(s):  
B SCHALLER ◽  
R HEILBRONNER ◽  
C PFALTZ ◽  
R PROBST ◽  
O GRATZL
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Nerve Function ◽  
Facial Nerve Function

Causes of Facial Nerve Paresis after Translabyrinthine Surgery for Acoustic Neuroma

1992 ◽  
Vol 101 (10) ◽  
pp. 821-826 ◽  
Author(s):  
Mirko Tos ◽  
Jens Thomsen ◽  
Mahmoud Youssef ◽  
Suat Turgut
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Acoustic Neuroma ◽  
Facial Palsy ◽  
Cerebellopontine Angle ◽  
Patient Records ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Common Site ◽  
Nerve Paresis

Forty-six consecutive video-recorded translabyrinthine operations at Gentofte Hospital, for tumors of 5 to 25 mm, were investigated for possible damage to the facial nerve from cauterization, suction, stretching, pushing, and other instrumental trauma at the following regions: fundus, internal meatus, porus, cerebellopontine angle, and brain stem. House-Brackmann grading of the postoperative facial nerve function was determined from the patient records for the 1st, 3rd, and 10th days and 3 months and 6 months postoperatively, as well as the final status. Suction on the nerve seems to be the most important factor for perioperative facial nerve damage. The most common site of damage was the porus region. This investigation shows thermic drilling lesions to be very relevant. There was no correlation between the degree and character of damage and the postoperative facial nerve function. In eight patients we cannot explain the postoperative facial palsy.

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