Acoustic (Loudspeaker) Facial EMG Monitoring: II. Use of Evoked EMG Activity during Acoustic Neuroma Resection

1987 ◽  
Vol 97 (6) ◽  
pp. 541-551 ◽  
Author(s):  
Richard L. Prass ◽  
Sam E. Kinney ◽  
Russell W. Hardy ◽  
Joseph F. Hahn ◽  
Hans Lüders
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Activity Patterns ◽  
Emg Activity ◽  
Surgical Trauma ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Facial Emg ◽  
Surgical Tool ◽  
Early Results

Facial electromyographic (EMG) activity was continuously monitored via loudspeaker during eleven translabyrinthine and nine suboccipital consecutive unselected acoustic neuroma resections. Ipsilateral facial EMG activity was synchronously recorded on the audio channels of operative videotapes, which were retrospectively reviewed in order to allow detailed evaluation of the potential benefit of various acoustic EMG patterns in the performance of specific aspects of acoustic neuroma resection. The use of evoked facial EMG activity was classified and described. Direct local mechanical (surgical) stimulation and direct electrical stimulation were of benefit in the localization and/or delineation of the facial nerve contour. Burst and train acoustic patterns of EMG activity appeared to indicate surgical trauma to the facial nerve that would not have been appreciated otherwise. Early results of postoperative facial function of monitored patients are presented, and the possible value of burst and train acoustic EMG activity patterns in the intraoperative assessment of facial nerve function is discussed. Acoustic facial EMG monitoring appears to provide a potentially powerful surgical tool for delineation of the facial nerve contour, the ongoing use of which may lead to continued improvement in facial nerve function preservation through modification of dissection strategy.

Facial Nerve Dissection by use of Acoustic (Loudspeaker) Facial EMG Monitoring

1986 ◽  
Vol 95 (4) ◽  
pp. 458-463 ◽  
Author(s):  
Sam E. Kinney ◽  
Richard Prass
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Internal Auditory Canal ◽  
Subsequent Development ◽  
Lateral Approach ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Facial Emg ◽  
Acoustic Neuroma Surgery ◽  
Total Tumor Removal

The development of the surgical microscope in 1953, and the subsequent development of microsurgical instrumentation, signaled the beginning of modern-day acoustic neuroma surgery. Preservation of facial nerve function and total tumor removal is the goal of all acoustic neuroma surgery. The refinement of the translabyrinthine removal of acoustic neuromas by Dr. William House’ significantly improved preservation of facial nerve function. This is made possible by the anatomic identification of the facial nerve at the lateral end of the internal auditory canal. When the surgery is accomplished from a suboccipital or retrosigmoid approach, the facial nerve may be identified at the brain stem or within the internal auditory canal. Identifying the facial nerve from the posterior approach is not as anatomically precise as from the lateral approach through the labyrinth. The use of a facial nerve stimulator can greatly facilitate Identification of the facial nerve in these procedures.

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.

Facial Nerve Function After Acoustic Neuroma Surgical Removal

2002 ◽  
Vol 23 (Sup 1) ◽  
pp. S40
Author(s):  
Ricardo F. Bento ◽  
Rubens V. de Brito ◽  
Tanit Ganz Sanchez
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Surgical Removal ◽  
Nerve Function ◽  
Facial Nerve Function

Observer variations in the evaluation of facial nerve function after acoustic neuroma surgery

1993 ◽  
Vol 107 (12) ◽  
pp. 1119-1121 ◽  
Author(s):  
Christian Buchwald ◽  
Mirko Tos ◽  
Jens Thomsen ◽  
Henrik MØller ◽  
Agnete Parving
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Nerve Function ◽  
Surgical Team ◽  
Facial Nerve Function ◽  
Face To Face ◽  
Translabyrinthine Approach ◽  
Acoustic Neuroma Surgery ◽  
Grading Scale

This investigation was performed in order to evaluate the observer variations in facial nerve function after surgery for an acoustic neuroma. From 1976–90, 507 patients were operated on by the same surgical team (M.T. and J.T.) using a translabyrinthine approach. One hundred and forty-four patients living in Copenhagen City and County were invited for interview and objective examination. Only 128 patients attended the interview and examination which were carried out by the same ENT physician. Data concerning observation of the facial nerve function only is presented. Its function was clinically evaluated (using the House and Brackmann (1985) grading scale) by two different observers i.e the ENT physician and one of the surgeons. The patients were asked face-to-face with the ENT physician to estimate the degree of facial nerve function according to a 0–100 per cent scale. Comparing normal and abolished facial nerve function the judgments of the ENT physician and the surgeon agreed with the patient‘s own evaluation.

scholarly journals Retrosigmoid Transmeatal Approach for Resection of Acoustic Neuroma: Operative Video and Technical Nuances of Subperineural Dissection for Facial Nerve Preservation

2019 ◽  
Vol 80 (S 03) ◽  
pp. S269-S270
Author(s):  
James K. Liu ◽  
Vincent N. Dodson ◽  
Robert W. Jyung
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Protective Layer ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tumor Removal ◽  
Nerve Preservation ◽  
Tumor Capsule ◽  
Acoustic Neuromas ◽  
Dissection Technique

The retrosigmoid (suboccipital) approach is the workhorse for most acoustic neuromas in the cerebellopontine angle. In this operative video atlas manuscript, the authors demonstrate the nuances of the subperineural dissection technique for microsurgical resection of an acoustic neuroma via the retrosigmoid transmeatal approach. The plane is developed by separating the perineurium of the vestibular nerve away from the tumor capsule. This perineurium provides a protective layer between the tumor capsule and the facial nerve which serves as a buffer to avoid direct dissection and potential trauma to the facial nerve. Using this technique during extracapsular tumor dissection helps to maximize the extent of tumor removal while preserving facial nerve function. A gross total resection of the tumor was achieved, and the patient exhibited normal facial nerve function (Fig. 1). In summary, the retrosigmoid transmeatal approach with the use of subperineural dissection are important strategies in the armamentarium for surgical management of acoustic neuromas with the goal of maximizing tumor removal and preserving facial nerve function (Fig. 2).The link to the video can be found at: https://youtu.be/L3lPtSvJt60.

scholarly journals Translabyrinthine Approach for Resection of Large Cystic Acoustic Neuroma: Operative Video and Technical Nuances of Subperineural Dissection for Facial Nerve Preservation

2019 ◽  
Vol 80 (S 03) ◽  
pp. S267-S268
Author(s):  
James K. Liu ◽  
Vincent N. Dodson ◽  
Robert W. Jyung
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas ◽  
Extracapsular Dissection ◽  
Cerebellar Retraction

The translabyrinthine approach is advantageous for the resection of large acoustic neuromas compressing the brainstem when hearing loss is nonserviceable. This approach provides wide access through the presigmoid corridor without prolonged cerebellar retraction. Early identification of the facial nerve at the fundus is also achieved. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a large cystic acoustic neuroma via a translabyrinthine approach. The nuances of microsurgical and skull base technique are illustrated including performing extracapsular dissection of the tumor while maintaining a subperineural plane of dissection to preserve the facial nerve. This strategy maximizes the extent of removal while preserving facial nerve function. A microscopic remnant of tumor was left adherent to the perineurium. A near-total resection of the tumor was achieved and the facial nerve stimulated briskly at low thresholds. Other than preexisting hearing loss, the patient was neurologically intact with normal facial nerve function postoperatively. In summary, the translabyrinthine approach and the use of subperineural dissection are important strategies in the armamentarium for surgical management of large acoustic neuromas while preserving facial nerve function.The link to the video can be found at: https://youtu.be/zld2cSP8fb8.

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