Value of intraoperative monitoring of the trigeminal nerve in detection of a superiorly displaced facial nerve during surgery for large vestibular schwannomas.
Electromyography
Facial nerve
Facial nerve displacement
Intraoperative monitoring
Trigeminal nerve
Vestibular schwannoma
Journal
Neurosurgical review
ISSN: 1437-2320
Titre abrégé: Neurosurg Rev
Pays: Germany
ID NLM: 7908181
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
12
03
2021
accepted:
10
09
2021
revised:
04
09
2021
pubmed:
18
9
2021
medline:
6
4
2022
entrez:
17
9
2021
Statut:
ppublish
Résumé
The aim of this study was to investigate the role of trigeminal and facial nerve monitoring in the early identification of a superiorly (anterior and superior (AS)) displaced facial nerve. This prospective study included 24 patients operated for removal of large vestibular schwannomas (VS). The latencies of the electromyographic (EMG) events recorded from the trigeminal and facial nerve innervated muscles after mapping the superior surface of the tumor were analyzed. The mean latency of the recorded compound muscle action potential (CMAP) from the masseter muscle was 3.6 ± 0.5 ms and of the peripherally transmitted responses by volume conduction from the frontalis, o. oculi, nasalis, o. oris, and mentalis muscles was 4.6 ± 0.9, 4.1 ± 0.7, 3.9 ± 0.4, 4.3 ± 0.8, and 4.5 ± 0.6 ms, respectively, after trigeminal nerve stimulation in 24 (100%) patients (pattern I response). In 6 (25%) patients, the mean latency of CMAP on the masseter was 3.3 ± 0.3 ms, and the latencies of the CMAP from the frontalis, o. oculi, nasalis, o. oris, and mentalis muscles were 6.5 ± 1.3, 5.0 ± 1.5, 7.5 ± 1.3, 7.4 ± 0.6, and 7.0 ± 1.5 ms, respectively, longer than those of the peripherally transmitted responses (p = 0.002, p = 0.001, p < 0.001, and p = 0.015, respectively) indicating simultaneous stimulation of both nerves (pattern II response). All patients with this response were later confirmed to have an AS-displaced facial nerve. Recognizing the response resulting from simultaneous stimulation of both the facial and trigeminal nerves is important to help early identification of an AS-displaced facial nerve before it is visible in the surgical field and to avoid misleading information by confusing this pattern for a pure trigeminal nerve response.
Identifiants
pubmed: 34533668
doi: 10.1007/s10143-021-01646-7
pii: 10.1007/s10143-021-01646-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1343-1351Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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