Influencing Factors Analysis of Facial Nerve Function after the Microsurgical Resection of Acoustic Neuroma

OBJECTIVE: To explore and analyze the influencing factors of facial nerve function retainment after microsurgery resection of acoustic neurinoma. METHODS: Retrospective analysis of our hospital 105 acoustic neuroma cases from October, 2006 to January 2012, in the group all patients were treated with suboccipital sigmoid sinus approach to acoustic neuroma microsurgery resection. We adopted researching individual patient data, outpatient review and telephone followed up and the House-Brackmann grading system to evaluate and analyze the facial nerve function. RESULTS: Among 105 patients in this study group, complete surgical resection rate was 80.9% (85/105), subtotal resection rate was 14.3% (15/105), and partial resection rate 4.8% (5/105). The rate of facial nerve retainment on neuroanatomy was 95.3% (100/105) and the mortality rate was 2.1% (2/105). Facial nerve function when the patient is discharged from the hospital, also known as immediate facial nerve function which was graded in House-Brackmann: excellent facial nerve function (House-Brackmann I–II level) cases accounted for 75.2% (79/105), facial nerve function III–IV level cases accounted for 22.9% (24/105), and V–VI cases accounted for 1.9% (2/105). Patients were followed up for more than one year, with excellent facial nerve function retention rate (H-B I–II level) was 74.4% (58/78). CONCLUSION: Acoustic neuroma patients after surgery, the long-term (≥1 year) facial nerve function excellent retaining rate was closely related with surgical proficiency, post-operative immediate facial nerve function, diameter of tumor and whether to use electrophysiological monitoring techniques; while there was no significant correlation with the patient’s age, surgical approach, whether to stripping the internal auditory canal, whether there was cystic degeneration, tumor recurrence, whether to merge with obstructive hydrocephalus and the length of the duration of symptoms.

Application of intraoperative nerve electrophysiological monitoring inlumbosacral spinal cord tumor resection / 西安交通大学学报(医学版)

Objective To study intraoperative neural electrophysiological monitoring applied in lumbosacral spinal cord tumor resection.Methods We retrospectively reviewed the clinical data of 212 patients undergoing lumbosacral spinal cord tumor resection with or without intraoperative neural electrophysiological monitoring in our hospital.The patients were divided into two groups:124 patients in the monitored group received intraoperative neural electrophysiological monitoring while 88 ones in the control group did not.The monitoring was performed by recording the cortical somatosensory evoked potential (CSEP),dermatomal somatosensory evoked potential (DSEP) and electromyography (EMG).The patients were followed up for 3-6 months and their postoperative outcome was analyzed.Results There were significant differences in the outcome (P <0.05),but no difference was found in the incidence of complications between the monitored group and the control group.The sensitivity of CSEP +DSEP+EMG was 100%,and the specificity was 55.9% in the former group.Conclusion Combined monitoring with CSEP,DSEP and EMG during lumbosacral spinal cord tumor resection is valuable in protecting the spinal nerve roots and ensuring better operation safety.

Application of neural electrophysiological monitoring in facial nerve microvascular decompression / 吉林大学学报(医学版)

Objective To expore the application of intraoperative neural electrophysiological monitoring in microvascular decompression (MVD)of idiopathic facial spasm (HFS), and to clarify the effect of MVD in increasing the operative efficacy of MVD and decreasing the postoperative complications.Methods From December 2010 to December 2014,163 patients with HFS received MVD were selected;from December 2010 to December 2010,73 patients with facial spasm without electrophysiological monitoring in the operation were used as control group;from January 2013 to December 2014,90 patients with facial spasm with BAEP/LSR/FN MEP monitoring in the operation were used as monitoring group.The postoperative efficiency of MVD and the occurrence of hearing loss,dizziness, facial paralysis and other complications after operation were compared between two groups. Results The immediate efficiency in monitoring group was 52.55% (47 cases), minor facial paralysis 1.11%(1 case),hearing loss and dizziness 5.56% (5 cases).The postoperative follow-up time was 6 to 12 months,an average of 9.6 months; the facial paralysis, hearing loss, and dizziness were significantly improved and the operation efficiency was 65.56% (59 cases).The Immediate efficiency in control group was 30.14% (22 cases), minor facial paralysis 13.69% (10 cases),hearing loss and dizziness 23.29% (17 cases);the postoperative follow-up time was 6 to 12 months,an average of 9.6 months;the facial paralysis,hearing loss,and dizziness were significantly improved, and the operation efficiency was 64.38% (47 cases ). The immediate surgery had statistically significant difference between two groups (P 0.05).The incidence of facial paralysis, hearing loss and the incidence of complications such as dizziness had statistically significant differences between two groups (P <0.05),and monitoring group was better than control group.Conclusion LSR monitoring can improve the short-term curative efficiency of facial nerve MVD,but the significance for the long-term curative efficiency is not obvious; BAEP, LSR and FN MEP monitoring have great significance in identification of responsibility vessel,judgement of decompression effect and surface and auditory nerves protection.

Clinical research on 46 cases of microoperation for acoustic neurinomas under the F wave assisted electrophysiological monitoring intraoperatively / 肿瘤研究与临床

ObjectiveTo study the methods of how to protect facial nerve function following complete resection of acoustic neurinomas and the value of the techniques of F wave assisted electrophysiological monitoring intraoperatively.Methods Retrospectivelysummarizing theresultsof combining three electrophysiological monitoring techniques such as nasal muscle F wave recording,online EMG and triggered EMG to monitor 46 cases of microoperations for acoustic neurinomas intraoperatively during the period of Feb.2004 to Dec. 2008. Correlating every intraoperative monitoring index with their follow-up results of facial nerve function 1 day and 6 months after their operations.The tendency of the two continuous monitoring techniques between nasal F wave recording and online EMG of facial muscles has also been studied in this paper. Results Among 46 cases of acoustic neurinomas, 45(97.83 %) tumors have been totally resected, and 1 (2.17 %) tumor subtotally resected,lcase (2.17 %)died after operation,and 2ases occurred the leakage of cerebrospinal fluid(CSF) which have been cured through conservative treatment. The whole anatomic protection rate of facial nerve is 97.83 %,and their functional protection rates 6 months after operation are:HB Ⅰ - Ⅱ,75.56 %;Ⅲ-Ⅳ,22.22 % and Ⅴ-Ⅵ,2.22 %.The completely accordant rate between the intraoperative findings of nasal F wave recording and online EMG is 52.17 %, partially accordant rate is 45.65 %, and totally opposite rate is 2.17 % (x2 趋势= 6.113, P ＜0.05). The intraoperative monitoring indexes in nasal muscle F wave recording are correlated well with the facial nerve function in the 6th month' s follow-up (κ=0.429, P ＜0.001).In triggered EMG monitoring after tumors being resected,the stimulus threshold ratio and maximum amplitude ratio of facial nerve between leaving brain stem part and inner acoustic porus part are also correlated well with the facial nerve function 6 months after operation(κ=0.576, P ＜0.001; κ=0.595, P ＜0.001). ConclusionNasal muscle F wa recording cooperated well with online EMG and triggered EMG intraoperatively and correlates well with the postoperative facial nerve function, so they should be routinely applied together intraoperatively.

Surgical Outcome and Intraoperative Electrophysiological Monitoring in Selective Posterior Rhizotomy

Selective posterior rhizotomy(SPR) has been known to reduce the spasticity as well as to improve the quality of life in patients with intractable spasticity. Twenty patients underwent SPR under intraoperative electrophysiological monitoring (IOM). Fifty-two percent of sacrolumbar rootlet were cut after electrical stimulation. Eighteen patients(90%) with spastic type of cerebral palsy showed marked reduction of spasticity and functional improvement without any complication. The patients who did not respond to SPR had mixed types of spasticity. IOM facilitate the selection of pathological rootlets regardless of anaesthetic level, intensity of electrical stimulation, and individual variability of responses. It is concluded that careful selection of surgical candidates and of pathological rootlets under IOM are important to reduce the spasticity, thereby to obtain a better outcome.