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Intra-operative facial nerve monitoring. Its predictive value after skull base surgery

Published online by Cambridge University Press:  29 June 2007

Giuseppe Magliulo  and
Francesco Zardo
Giuseppe Magliulo*
Affiliation:
IVth ENT Clinic, University ‘La Sapienza’ – Rome, Italy.
Francesco Zardo
Affiliation:
IVth ENT Clinic, University ‘La Sapienza’ – Rome, Italy.
*
Address for correspondence: Giuseppe Magliulo, M.D., via Gregorio VII 80, 00165 Roma, Italy.
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Abstract

Purpose

Facial nerve monitoring can be used to predict post-operative facial function after skull base surgery. In this study three methods of prediction of facial function were compared. These methods utilize various parameters of the evoked electromyographic monitoring.

Material and methods

Twenty-three patients who underwent surgery for skull base diseases were retrospectively reviewed. Amplitude of ongoing electromyographic activity, stimulation current thresholds and amplitude of evoked response were analysed. The predictive value of the three methods was correlated with post-operative facial nerve function.

Results

The method that used only the stimulation thresholds predicted the final post-operative facial function in 86.9 per cent of the patients. The second employed a mathematical ratio which combined the amplitude of evoked response and the stimulation current thresholds and confirmed the prediction of the facial function in 91.3 per cent of the patients. The last method does not consider the stimulation thresholds greater than 0.05 mA and failed to predict the final VIIth nerve function in patients in whom the stimulation was greater than 0.05 mA.

Conclusion

Analysis of prognostic value demonstrates that the first two methods had the smaller degree of variation showing the better sensitivity.

Keywords

Facial nerveMonitoring, physiologicalSkull base, surgery
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 111 , Issue 8 , August 1997 , pp. 715 - 718
Copyright
Copyright © JLO (1984) Limited 1997

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References

Beck, D. L., Atkins, J. S., Benecke, J. E., Brackmann, D. E. (1991) Intraoperative facial nerve monitoring: Prognostic aspects during acoustic tumor removal. Otolaryngology – Head and Neck Surgery 104: 780–782.CrossRefGoogle ScholarPubMed
Benecke, J., Calder, H. B., Chadwick, G. (1987) Facial nerve monitoring during acoustic neuroma removal. Laryngoscope 97: 697–700.CrossRefGoogle ScholarPubMed
Berges, C., Fraysse, B., Yardeni, E., Rugiu, G. (1993) Intraoperative facial nerve monitoring in posterior fossa surgery: prognostic value. Skull Base Surgery 3: 214–216.CrossRefGoogle ScholarPubMed
Delgado, T. E., Buccheit, W. A., Rosenholtz, H. R., Chrissian, S. (1979) Intraoperative monitoring of facial muscle evoked response obtained by intracranial stimulation of facial nerve: A more accurate technique for facial nerve dissection. Neurosurgery 4: 418–421.CrossRefGoogle Scholar
Harner, S. G., Daube, J. R., Beatty, C. W. (1988) Intraoperative monitoring of facial nerve. Laryngoscope 98: 209–212.CrossRefGoogle ScholarPubMed
House, J., Brackmann, D. E. (1985) Facial nerve grading system. Otolaryngology – Head and Neck Surgery 93: 146–147.CrossRefGoogle ScholarPubMed
Kartush, J. M., Niparko, J. K., Bledsoe, S. C., Graham, M. D., Kemink, J. L. (1985) Intraoperative monitoring. A comparison of stimulation electrodes. Laryngoscope 95: 1536–1539.CrossRefGoogle Scholar
Kartush, J. M., Laroure, M. J., Graham, M. D., Bouchard, K. R., Audet, B. V. (1991) Intraoperative cranial nerve monitoring during posterior skull base surgery. Skull Base Surgery 1: 85–92.CrossRefGoogle ScholarPubMed
Kirkpatrick, P. J., Walters, M. B., Strong, A. J., Walliker, M. A., Gleeson, M. J. (1991) Prediction of facial nerve function after surgery for cerebellopontine angle tumors. Use of a facial nerve stimulator and monitor. Skull Base Surgery 1: 171–176.CrossRefGoogle ScholarPubMed
Leonetti, J. P., Brackmann, D. E., Prass, R. L. (1989) Improved preservation of facial nerve function in the infratemporal approach of the skull base. Otolaryngology – Head and Neck Surgery 101: 74–78.CrossRefGoogle ScholarPubMed
Lye, R. H., Dutton, J., Ramsden, R. T., Occleshaw, J. V., Ferguson, I. T., Taylor, I. (1982) Facial nerve preservation during surgery for removal of acoustic neuroma tumors. Journal of Neurosurgery 57: 739–746.CrossRefGoogle Scholar
Magliulo, G., Petti, R., Vingolo, G. M., Ronzoni, R., Cristofari, P. (1994a) Facial nerve monitoring of skull base and cerebellopontine angle lesions. European Archives of Otolaryngology (Suppl): 314–315.Google ScholarPubMed
Magliulo, G., Petti, R., Vingolo, G. L. M., Cristofari, P., Ronzoni, R. (1994b) Facial nerve monitoring in skull base surgery. Journal of Laryngology and Otology 108: 557–559.CrossRefGoogle ScholarPubMed
Moller, A. R., Jannetta, P. J. (1984) Preservation of facial function during removal of acoustic neuromas. Journal of Neurosurgery 61: 757–760.CrossRefGoogle ScholarPubMed
Prass, R., Luders, H. (1986) Facial electromyographic monitoring: evoked electromyographic activity during acoustic neuroma resection. Neurosurgery 19: 392–400.Google ScholarPubMed
Prass, R. L., Kinney, S. E., Hardy, R. W., Hahn, J. F., Luders, H. (1987) Acoustic (loudspeaker) facial EMG monitoring: Use of evoked EMG activity during acoustic neuroma resection (part 2). Otolaryngology – Head and Neck Surgery 97: 542–551.CrossRefGoogle Scholar
Silverstein, H., Smohua, E. E., Jones, R. (1988) Routine intraoperative facial nerve monitoring during otologic surgery. American Journal of Otology 9: 269–275.Google ScholarPubMed
Silverstein, H., Willcox, T. O., Rosenberg, S. I., Seidman, M. D. (1994) Prediction of facial nerve function following acoustic neuroma resection using intraoperative facial nerve stimulation. Laryngoscope 104: 539–544.CrossRefGoogle ScholarPubMed