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Intraoperative electromyography and surgical observations as predictive factors of facial nerve outcome in vestibular schwannoma surgery.
Bernat, Isabelle; Grayeli, Alexis Bozorg; Esquia, Gonzalo; Zhang, Zhihua; Kalamarides, Michel; Sterkers, Olivier.
Afiliação
  • Bernat I; AP-HP, Hôpital Beaujon, Otolaryngology Department, Clichy, France.
Otol Neurotol ; 31(2): 306-12, 2010 Feb.
Article em En | MEDLINE | ID: mdl-19816232
ABSTRACT

OBJECTIVE:

To evaluate the predictive value of electromyographic recordings for the immediate facial nerve outcome after solitary vestibular schwannoma (VS) removal. STUDY

DESIGN:

Prospective cohort study.

SETTING:

Tertiary referral center. PATIENTS AND

METHODS:

From November 2005 to July 2007, 120 operated solitary VSs monitored by NIM Response 2.0 (Medtronic, Xomed, Jacksonville, FL, USA) were included. Intraoperative direct facial nerve stimulation at the brainstem (proximal pre site) before resection and at the brainstem (proximal post and distal sites, respectively) and internal acoustic meatus after resection were performed. Intraoperative recordings were performed on 4 muscles Frontalis, Orbicularis oculi, Orbicularis oris, and chin muscles (CM). Postoperative facial function (House-Brackmann classification) was evaluated at postoperative Days (D) 2, 8, and 30. Grades 1 or 2 were considered as a good result.

RESULTS:

A good postoperative facial function was obtained in 71, 63, and 77% at postoperative D2, D8, and D30, respectively. Maximal conduction block was found at Day 8. Poor facial nerve outcomes were observed for large tumor with a facial nerve superior to the tumor with a strong adhesion to the nerve. With a stimulation threshold at proximal site after proximal site tumor resection at less than or equal to 0.04 mA, a good facial function was observed in 77% at Day 8. Using these criteria together with CM responses greater than 800 muV to supramaximal stimulation at (proximal post site) and a proximal/distal post ratio at CM response greater than 0.6, 93% of patients presented with a good facial function at Day 8.

CONCLUSION:

Using CM recording stimulation and supramaximal stimulation of the facial nerve in combination with thresholds seem to increase the predictive value of the monitoring for the immediate facial nerve function for VS surgery.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Procedimentos Cirúrgicos Otológicos / Neoplasias da Orelha / Neuroma Acústico / Traumatismos do Nervo Facial Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Otol Neurotol Assunto da revista: NEUROLOGIA / OTORRINOLARINGOLOGIA Ano de publicação: 2010 Tipo de documento: Article País de afiliação: França

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Procedimentos Cirúrgicos Otológicos / Neoplasias da Orelha / Neuroma Acústico / Traumatismos do Nervo Facial Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Otol Neurotol Assunto da revista: NEUROLOGIA / OTORRINOLARINGOLOGIA Ano de publicação: 2010 Tipo de documento: Article País de afiliação: França