scholarly journals Setting the Standard – UK Neurosurgical Acoustic Neuroma Practice

2006 ◽  
Vol 88 (5) ◽  
pp. 486-489 ◽  
Author(s):  
JR Goodden ◽  
R Tranter ◽  
C Hardwidge
Keyword(s):  
Facial Nerve ◽  
Current Practice ◽  
Clinical Effectiveness ◽  
Nerve Monitoring ◽  
Surgical Practice ◽  
Acoustic Neuromas ◽  
Facial Nerve Monitoring ◽  
Surgical Expertise ◽  
Unfit Patients ◽  
The Uk

INTRODUCTION The aim of this study was to determine how current practice in the UK and Ireland complies with the Clinical Effectiveness Guidelines for the Management of Acoustic Neuromas. MATERIALS AND METHODS A survey of units and consultants using a standardised questionnaire was carried out. RESULTS Fifty-six neurosurgeons treat acoustic neuromas in 33 out of 34 units. In 27 units, one or two surgeons specialise in this area. Caseload per annum per surgeon ranged from 2 to 30, median 15. Forty-one neurosurgeons (75%) work with an ENT surgeon. All surgeons use facial nerve monitoring during surgery. All neurosurgeons informed patients about stereotactic radiosurgery, tending to recommend it for medically unfit patients, and those with small tumours. CONCLUSIONS Overall, 26 units (79%) and 40 surgeons (73%) met the criteria for good surgical practice. The main reasons for non-compliance were a lack of teamwork with ENT, and insufficient caseload to maintain surgical expertise.

Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas

2012 ◽  
Vol 33 (3) ◽  
pp. E6 ◽  
Author(s):  
Taemin Oh ◽  
Daniel T. Nagasawa ◽  
Brendan M. Fong ◽  
Andy Trang ◽  
Quinton Gopen ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Intraoperative Neuromonitoring ◽  
Auditory Evoked Potential ◽  
Vestibulocochlear Nerve ◽  
Monitoring Method ◽  
Nerve Monitoring ◽  
Acoustic Neuromas ◽  
Facial Nerve Monitoring ◽  
Potential Monitoring

Unfavorable outcomes such as facial paralysis and deafness were once unfortunate probable complications following resection of acoustic neuromas. However, the implementation of intraoperative neuromonitoring during acoustic neuroma surgery has demonstrated placing more emphasis on quality of life and preserving neurological function. A modern review demonstrates a great degree of recent success in this regard. In facial nerve monitoring, the use of modern electromyography along with improvements in microneurosurgery has significantly improved preservation. Recent studies have evaluated the use of video monitoring as an adjunctive tool to further improve outcomes for patients undergoing surgery. Vestibulocochlear nerve monitoring has also been extensively studied, with the most popular techniques including brainstem auditory evoked potential monitoring, electrocochleography, and direct compound nerve action potential monitoring. Among them, direct recording remains the most promising and preferred monitoring method for functional acoustic preservation. However, when compared with postoperative facial nerve function, the hearing preservation is only maintained at a lower rate. Here, the authors analyze the major intraoperative neuromonitoring techniques available for acoustic neuroma resection.

Intraoperative Facial Nerve Monitoring

1991 ◽  
Vol 24 (3) ◽  
pp. 709-725 ◽  
Author(s):  
Herbert Silverstein ◽  
Seth Rosenberg
Keyword(s):  
Facial Nerve ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring

scholarly journals Clinical Benefits of Facial Nerve Monitoring during Cerebellopontine Angle Surgery

2022 ◽  
Vol 12 (01) ◽  
pp. 9-27
Author(s):  
Ahmed A. Farag ◽  
Abd El-Kafy Sharaf El-Din Ibrahim ◽  
Islam M. Alaghory
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Clinical Benefits

Additional Benefits of Facial Nerve Monitoring during Otologic Surgery

2020 ◽  
Vol 163 (3) ◽  
pp. 572-576
Author(s):  
Kelsey Casano ◽  
Gerard Giangrosso ◽  
Gauri Mankekar ◽  
Alexander Sevy ◽  
Rahul Mehta ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Structured Interviews ◽  
Nerve Monitoring ◽  
Tertiary Referral Center ◽  
Otologic Surgery ◽  
Increased Risk ◽  
Facial Nerve Monitoring ◽  
Adults And Children ◽  
Facial Nerve Stimulation

Objective This study assesses the role of facial nerve monitoring (FNM) for intraoperative decision making during otologic surgery and possible benefits beyond protecting facial nerve integrity. Study Design This prospective study examines intraoperative FNM data and structured interviews collected during 52 otologic procedures. Setting Tertiary referral center. Subjects and Methods Subjects include adults and children undergoing middle ear or mastoid surgery. Data include intraoperative neuromonitoring activity and structured interviews conducted with the operating surgeon immediately following surgery. Results Facial nerve stimulation was used to confirm the position of the nerve in 42 of 52 surgical procedures. In 26.9% of cases, the patient became “light” and moved under anesthesia, which was predicted by neuromonitoring 71.4% of the time. Through structured interviews, the operating surgeons reported the following. (1) The facial nerve took an unexpected anatomic course in 7.8% of patients and was difficult to identify in 39.2%. (2) The nerve was at increased risk of injury in 66.7% of cases due to chronic disease or previous surgery. (3) Among these high-risk cases, the monitor helped reduce the risk of nerve damage 100% of the time. (4) Neuromonitoring allowed the surgeon to operate faster 86.5% of the time, and (5) FNM allowed the resident to perform more of the operation 68.9% of the time. No patients experienced postoperative facial weakness. Conclusions Beyond potentially protecting facial nerve integrity, this study identified additional benefits of FNM, including warning of patient movement during anesthesia, confirming facial nerve anatomic location, reducing operative time, and enhancing resident surgical experience.

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