Publication year: 2011
Source: World Neurosurgery, Available online 1 November 2011
Marcus André Acioly, Marina Liebsch, Paulo Henrique Pires de Aguiar, Marcos Tatagiba
ObjectiveIntraoperative neuromonitoring has been established as one of the methods in which modern neurosurgery can improve surgical results while reducing morbidity. Despite routine use of intraoperative facial nerve (FN) monitoring, FN injury still is a complication of major concern due to severe negative impact on patient's quality of life.MethodsThrough searches of Pubmed, we provided a systematic review of the current literature up to February, 2011 emphasizing all respects of FN monitoring for cerebellopontine angle and skull base tumor surgery from description to current success on function prediction of standard and emerging monitoring techniques.ResultsCurrently, standard monitoring techniques comprise direct electrical stimulation (DES), free running electromyography (EMG) and facial motor evoked potential (FMEP). We included 62 studies on function prediction by investigating DES (43 studies), free running EMG (13 studies), and FMEP (6 studies) criteria. DES mostly evaluated postoperative function by using absolute amplitude, stimulation threshold, and proximal-to-distal amplitude ratio, while free running EMG used the train-time criterion. The prognostic significance of FMEP was assessed with the final-to-baseline amplitude ratio, as well as the event-to-baseline amplitude ratio and waveform complexity.ConclusionEven though there is a general agreement in the satisfactory functional prediction of different electrophysiological criteria, the lack of standardization in electrode montage, and stimulation parameters precludes a definite conclusion regarding the best method. Moreover, studies emphasizing comparison between criteria or even multimodal monitoring and its impact on FN anatomical and functional preservation are still lacking in the literature.
Source: World Neurosurgery, Available online 1 November 2011
Marcus André Acioly, Marina Liebsch, Paulo Henrique Pires de Aguiar, Marcos Tatagiba
ObjectiveIntraoperative neuromonitoring has been established as one of the methods in which modern neurosurgery can improve surgical results while reducing morbidity. Despite routine use of intraoperative facial nerve (FN) monitoring, FN injury still is a complication of major concern due to severe negative impact on patient's quality of life.MethodsThrough searches of Pubmed, we provided a systematic review of the current literature up to February, 2011 emphasizing all respects of FN monitoring for cerebellopontine angle and skull base tumor surgery from description to current success on function prediction of standard and emerging monitoring techniques.ResultsCurrently, standard monitoring techniques comprise direct electrical stimulation (DES), free running electromyography (EMG) and facial motor evoked potential (FMEP). We included 62 studies on function prediction by investigating DES (43 studies), free running EMG (13 studies), and FMEP (6 studies) criteria. DES mostly evaluated postoperative function by using absolute amplitude, stimulation threshold, and proximal-to-distal amplitude ratio, while free running EMG used the train-time criterion. The prognostic significance of FMEP was assessed with the final-to-baseline amplitude ratio, as well as the event-to-baseline amplitude ratio and waveform complexity.ConclusionEven though there is a general agreement in the satisfactory functional prediction of different electrophysiological criteria, the lack of standardization in electrode montage, and stimulation parameters precludes a definite conclusion regarding the best method. Moreover, studies emphasizing comparison between criteria or even multimodal monitoring and its impact on FN anatomical and functional preservation are still lacking in the literature.
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