Orthodromic (Intra/Extracranial) Neurography to Monitor Facial Nerve Function Intraoperatively

Neurosurgery ◽  
1988 ◽  
Vol 22 (5) ◽  
pp. 945-950 ◽  
Author(s):  
U. D. Schmid ◽  
M. Sturzenegger ◽  
H. P. Ludin ◽  
R. W. Seiler ◽  
H. J. Reulen
Keyword(s):  
Facial Nerve ◽  
Evoked Potential ◽  
Cranial Nerves ◽  
Nerve Function ◽  
Signal Averaging ◽  
Facial Nerve Function ◽  
Tumor Capsule ◽  
Stylomastoid Foramen ◽  
Lower Cranial Nerves ◽  
Stimulation Of

Abstract This report introduces the technique of orthodromic neurography for monitoring of facial nerve function during operation in the cerebellopontine angle. By stimulation of the intracisternal segment of the facial nerve, a compound nerve action potential with amplitudes of 15 to 480 μV can be recorded extracranially from the nerve near the stylomastoid foramen after 0.95 to 2.27 ms. Usually there is no need for signal averaging, and the method is independent of the effect of muscle relaxants. With the use of the same electrophysiological equipment as for evoked potential neuromonitoring, immediate and repeated localization of the facial nerve and its discrimination from the trigeminal and the lower cranial nerves during nerve preparation within the tumor capsule is possible.

Facial Nerve Evoked Potentials in the Cat

1988 ◽  
Vol 98 (2) ◽  
pp. 130-137 ◽  
Author(s):  
Ralph Metson
Keyword(s):  
Facial Nerve ◽  
Evoked Potential ◽  
Indirect Inference ◽  
Nerve Function ◽  
Human Beings ◽  
Stimulation Site ◽  
Signal Averaging ◽  
Facial Nerve Function ◽  
Proximal Site ◽  
Stimulation Of

Electrophysiologic facial nerve testing usually involves stimulation of the peripheral nerve in order to make some indirect inference about nerve integrity at a more proximal site of lesion. In an attempt to develop a test of facial nerve function by use of across-the-lesion testing, the cat facial nerve was stimulated percutaneously at the stylomastold foramen while retrograde activity through the temporal bone and cranium was monitored with scalp electrodes. A biphasic evoked potential could be identified within 3 milliseconds of stimulation with the use of a signal-averaging computer. This potential remained when the animal was paralyzed and disappeared when the facial nerve was cut proximal to the stimulation site. A potential of similar latency and duration but larger amplitude was recorded from the subarachnold space. Mapping studies indicated its origin to be a dipole located between ipsilateral mastoid and parietal recording sites that corresponded to the region of the intracranial facial nerve. Optimal stimulation and recording techniques for subsequent studies of human beings are discussed.

Role of Facial Nerve Motor-Evoked Potential Ratio in Predicting Facial Nerve Function in Vestibular Schwannoma Surgery Both Immediate and at 1 Year

2016 ◽  
Vol 37 (8) ◽  
pp. 1162-1167 ◽  
Author(s):  
Sanjiv K. Bhimrao ◽  
Trung N. Le ◽  
Charles C. Dong ◽  
Serge Makarenko ◽  
Sarin Wongprasartsuk ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Nerve Function ◽  
Facial Nerve Function

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.

Hypoglossal-Facial Nerve Anastomosis: A Meta-Analytic Study

2007 ◽  
Vol 116 (7) ◽  
pp. 542-549 ◽  
Author(s):  
Sertac Yetiser ◽  
Ugur Karapinar
Keyword(s):  
Facial Nerve ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cranial Nerves ◽  
Facial Nerve Paralysis ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Reliable Technique ◽  
Nerve Paralysis ◽  
Nerve Anastomosis

Objectives: A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed. Methods: Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded 109 articles. The data were pooled from existing literature written in English or French. Twenty-three articles were included in the study after we excluded those that were technical reports, those describing anastomosis to cranial nerves other than the hypoglossal, and those that were experimental animal studies. Articles that reported facial nerve function after surgery and timing of repair were included. Facial nerve function had to be reported according to the House-Brackmann scale. If there was more than 1 article by the same author(s), only the most recent article and those that did not overlap and that matched the above criteria were accepted. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. This parameter was compared among all groups with Pearson's X2 test in the SPSS program for Windows. Statistical significance was set at a p level of less than .05. Results: Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. The severity of facial nerve paralysis does not have a negative effect on prognosis. Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. Modification of the anastomosis technique seems to resolve this problem. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports. Conclusions: Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.

Congenital facial nerve agenesis

2001 ◽  
Vol 115 (1) ◽  
pp. 53-54 ◽  
Author(s):  
P. N. Jervis ◽  
P. D. Bull
Keyword(s):  
Surgical Treatment ◽  
Parotid Gland ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Facial Palsy ◽  
Surgical Procedure ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Stylomastoid Foramen ◽  
Unrelated Condition

We present a case of a seven-year-old child with a congenital facial palsy, diagnosed at birth, who subsequently developed a non-tuberculous mycobacterial (NTM) infection of the ipsilateral parotid gland. This required parotid exploration to treat the NTM disease with the intention of identifying and protecting the facial nerve to preserve any residual facial nerve function. At operation, thorough exploration revealed the complete absence of the nerve both at the stylomastoid foramen and more peripherally within the substance of the parotid gland. Exploration of the facial nerve for congenital facial paralysis is not normally indicated. Surgical treatment, if required, tends to involve the use of techniques such as cross facial nerve and free vascularized muscle grafting. To our knowledge this is the first reported case of complete congenital facial nerve agenesis, diagnosed incidentally during a surgical procedure for an unrelated condition.

Role of electrophysiology in guiding near-total resection for preservation of facial nerve function in the surgical treatment of large vestibular schwannomas

2018 ◽  
Vol 128 (3) ◽  
pp. 903-910 ◽  
Author(s):  
Daniele Bernardeschi ◽  
Nadya Pyatigorskaya ◽  
Antoine Vanier ◽  
Franck Bielle ◽  
Mustapha Smail ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Facial Nerve ◽  
Residual Tumor ◽  
Incomplete Resection ◽  
Nerve Function ◽  
Inclusion Criteria ◽  
Facial Nerve Function ◽  
Total Resection ◽  
Supramaximal Stimulation ◽  
Stimulation Of

OBJECTIVEIn large vestibular schwannoma (VS) surgery, the facial nerve (FN) is at high risk of injury. Near-total resection has been advocated in the case of difficult facial nerve dissection, but the amount of residual tumor that should be left and when dissection should be stopped remain controversial factors. The objective of this study was to report FN outcome and radiological results in patients undergoing near-total VS resection guided by electromyographic supramaximal stimulation of the FN at the brainstem.METHODSThis study was a retrospective analysis of a prospectively maintained database. Inclusion criteria were surgical treatment of a large VS during 2014, normal preoperative FN function, and an incomplete resection due to the strong adherence of the tumor to the FN and the loss of around 50% of the response of supramaximal stimulation of the proximal FN at 2 mA. Facial nerve function and the amount and evolution of the residual tumor were evaluated by clinical examination and by MRI at a mean of 5 days postoperatively and at 1 year postoperatively.RESULTSTwenty-five patients met the inclusion criteria and were included in the study. Good FN function (Grade I or II) was observed in 16 (64%) and 21 (84%) of the 25 patients at Day 8 and at 1 year postoperatively, respectively. At the 1-year follow-up evaluation (n = 23), 15 patients (65%) did not show growth of the residual tumor, 6 patients (26%) had regression of the residual tumor, and only 2 patients (9%) presented with tumor progression.CONCLUSIONSNear-total resection guided by electrophysiology represents a safe option in cases of difficult dissection of the facial nerve from the tumor. This seems to offer a good compromise between the goals of preserving facial nerve function and achieving maximum safe resection.

Quantitative parameters of facial motor evoked potential during vestibular schwannoma surgery predict postoperative facial nerve function

2011 ◽  
Vol 153 (6) ◽  
pp. 1169-1179 ◽  
Author(s):  
Marcus André Acioly ◽  
Alireza Gharabaghi ◽  
Marina Liebsch ◽  
Carlos Henrique Carvalho ◽  
Paulo Henrique Aguiar ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Quantitative Parameters

scholarly journals Traumatic facial nerve palsy: evaluation and surgical management

2020 ◽  
Vol 6 (6) ◽  
pp. 1111
Author(s):  
Chaitry K. Shah ◽  
Shalu Gupta ◽  
Bela J. Prajapati ◽  
Devang P. Gupta ◽  
Viral Prajapati
Keyword(s):  
Facial Nerve ◽  
Surgical Management ◽  
Facial Palsy ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Cranial Nerves ◽  
Surgical Decompression ◽  
Nerve Function ◽  
Good Recovery ◽  
Facial Nerve Function

<p class="abstract"><strong>Background:</strong> Acute facial paralysis can result from various causes, among which intra temporal facial palsy is relatively common. Of all the cranial nerves, the facial nerve is most susceptible to injury due to its long course within the skull. Diagnosis of facial palsy is usually made by a good clinical history, examination and radiological investigations. Electrophysiological tests are important for prognosis and optimal time for surgery. The aim is to study the evaluation and surgical management in traumatic cause of facial nerve palsy.</p><p class="abstract"><strong>Methods:</strong> This prospective cross-sectional study was carried out in 50 patients presented with facial nerve palsy due to trauma in civil hospital Ahmedabad over a period of 1 year from May 2018 to 2019. Patients were examined and graded using House and Brackmann grading system. All the patients were evaluated and treated by surgical decompression. Follow up was carried out upto 6 months.  </p><p class="abstract"><strong>Results:</strong> The cause of facial nerve palsy in all 50 patients was accidental head trauma. All the patients were managed by surgical decompression. 46 out of 50 patients managed surgically had good recovery with restoration of complete facial nerve function. 4 out 50 patients had poor recovery due to late presentation.  </p><p class="abstract"><strong>Conclusions:</strong> Early initiation of treatment is important for favorable recovery of facial nerve function after trauma. Surgical treatment is indicated in suspected bony impingement of nerve. Surgical decompression if done early usually results in very good recovery.  </p>

scholarly journals Facial nerve preservation in stereotactic radiosurgery of tumors of the cerebellopontine cistern

2021 ◽  
Vol 23 (2) ◽  
pp. 57-65
Author(s):  
S. R. Ilyalov ◽  
K. M. Kvashnin ◽  
K. E. Medvedeva ◽  
A. A. Baulin ◽  
O. G. Lepilina ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Tumor Volume ◽  
Cranial Nerves ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Facial Paresis ◽  
Previous Surgery ◽  
Study Objective ◽  
The Mean

Introduction. Surgery has traditionally remained the main treatment for tumors of the cerebellopontine cistern but is associated with high risks of dysfunction of the cranial nerves. Radiosurgery is usually performed both as an adjuvant treatment and as an independent option.The study objective is to assess the safety of routine use of radiosurgery to preserve facial nerve function in the treatment of tumors of different origins located in the cerebellopontine cistern.Materials and methods. Since March 2018 to March 2020 there were 145 patients with tumors of cerebellopontine cistern (CPC) at the Center for High-Precision Radiology. Vestibilar schwannomas were detected in 116 (80 %) patients, in 37 cases - relapses or remains after surgery. The 22 patients had meningiomas, 6 after open surgery (WHO I). Trigeminal schwannomas - in 3 patients, facial schwannomas - in 2, jugular schwannomas - in 1 and metastasis of prostate cancer - in 1. 31 patients had facial paresis of different degrees after previous surgery. Among non-operated patients, facial paresis before radiosurgery was observed in only 1 patient. Radiosurgery was performed using the Leksell Gamma Knife Perfexion, the mean marginal dose was 12.2 Gy (11-15 Gy), the mean tumor volume was 3.98 cm3 (0.06-17.47 cm3).Results. Follow-up was performed in 85 patients. The mean follow-up was 359.3 days (91-776), the median follow-up was 367 days. Reduction of the tumor volume was detected in 27 patients, stabilization of the process in 15. The average decrease was 23.9 % (95 % CI 16.8-31.0 %). Transient postirradiation increase was observed in 30 patients only in the group of schwannomas and mean tumor volume increase was 53.7 % (95 % CI 38.5-68.9 %). In patients with previous surgery there were not cases of decline or regression facial paresis. Among patients who had not been operated on before radiosurgery, only in 1 case was the development of facial paresis (House-Brackman III) 5 months after irradiation, which amounted to 1.8 %. It should be especially noted that facial nerve function remained unchanged (House-Brackman I) in both patients with facial schwannomas. Also, not a single case of hemifacial spasm was identified.Conclusion. Radiosurgery of CPC tumors with a marginal dose from 12 to 15 Gy has a high degree of safety in relation to the facial nerve. This makes it possible to justify radiosurgery as alternative to traditional neurosurgical interventions.

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