ABSTRACT
We present a rare case of traumatic facial and vestibulocochlear nerve injury in the internal acoustic canal in the absence of a temporal bone fracture. A 2.5-year-old female presented with sudden-onset left-sided facial paralysis and ipsilateral total hearing loss after being hit by a falling television. High-resolution computed tomography revealed an occipital fracture line that spared the temporal bone and otic capsule. Diagnostic auditory brainstem response testing showed that wave V at 90-db normal hearing level was absent in the left ear. Needle electromyography revealed severe axonal injury. Facial paralysis regressed to House-Brackmann grade IV 9 months after the trauma, and no surgical intervention was scheduled. Traumatic facial and vestibulocochlear nerve injury can occur in the absence of a temporal bone fracture. Thus, careful evaluation of the internal acoustic canal is mandatory if concurrent 7th and 8th cranial nerve paralyses exist with no visible fracture line.
Subject(s)
Deafness/diagnosis , Facial Nerve Injuries/complications , Facial Paralysis/diagnosis , Skull Fractures/diagnostic imaging , Child, Preschool , Conservative Treatment , Deafness/etiology , Diffuse Axonal Injury/diagnosis , Diffuse Axonal Injury/physiopathology , Ear, Inner/innervation , Ear, Inner/pathology , Electromyography/methods , Evoked Potentials, Auditory, Brain Stem/physiology , Facial Nerve/pathology , Facial Nerve Injuries/diagnosis , Facial Nerve Injuries/physiopathology , Facial Paralysis/etiology , Female , Humans , Magnetic Resonance Imaging/methods , Severity of Illness Index , Skull Fractures/pathology , Temporal Bone/diagnostic imaging , Tomography, X-Ray Computed/methods , Vestibulocochlear Nerve Injuries/complications , Vestibulocochlear Nerve Injuries/diagnosisABSTRACT
BACKGROUND: Cranial nerve VIII is at risk during microvascular decompression (MVD) for hemifacial spasm (HFS). The primary aim of this study is to evaluate the empirical factors associated with brainstem auditory evoked potential monitoring and its correlation to post operative hearing loss (HL) after MVD for HFS. METHODS: Pre-operative and post-operative audiogram data and BAEP from ninety-four patients who underwent MVD for HFS were analyzed. Pure tone audiometry (PTA) and Speech Discrimination Score (SDS) were performed on all patients before and after surgery. Intraoperative neurophysiological data were reviewed independently. HL was assessed using the AAO-HNS classification system for non-serviceable hearing loss (Class C/D), defined as PTA >50 dB and/or SDS <50% within the speech range of frequencies. RESULTS: Patients with HL had higher rates of loss in the amplitude of wave V and prolongation in the interpeak latency of peak I-V latency during MVD. Gender, age, side, and MVD duration did not increase the risk of HL. There was no correlation between successive number of BAEP changes (reflective of the number of surgical attempts) and HL. There was no association between the speed of recovery of BAEPs and HL. CONCLUSIONS: Patients with new post-operative HL have a faster rate of change in the amplitude of wave V and the interpeak I-V latency during intraoperative BAEP monitoring for HFS. Our alarm criteria to inform the surgeon about impending nerve injury might have to be modified and prospectively tested to prevent rapid change in BAEPs.
Subject(s)
Evoked Potentials, Auditory, Brain Stem , Hearing Loss/prevention & control , Hemifacial Spasm/surgery , Microvascular Decompression Surgery/methods , Monitoring, Intraoperative/methods , Vestibulocochlear Nerve Injuries/diagnosis , Vestibulocochlear Nerve Injuries/prevention & control , Audiometry, Pure-Tone , Deafness/diagnosis , Deafness/prevention & control , Female , Hearing Loss/diagnosis , Humans , Intraoperative Complications/diagnosis , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Male , Microvascular Decompression Surgery/adverse effects , Middle Aged , Retrospective Studies , Vestibulocochlear Nerve Injuries/etiologyABSTRACT
OBJECT: Microvascular decompression (MVD) of the facial nerve is an effective treatment for patients with hemifacial spasm. Intraoperative monitoring of brainstem auditory evoked potentials (BAEPs) during MVD can reduce the incidence of hearing loss. In this study the authors' goal was to evaluate changes in interpeak latencies (IPLs) of Waves I-V, Waves III-V, and Waves I-III of BAEP Waveforms I, III, and V during MVD and correlate them with postoperative hearing loss. To date, no such study has been performed. Hearing loss is defined as nonuseful hearing (Class C/D), which is a pure tone average of more than 50 dB and/or speech discrimination score of less than 50%. METHODS: The authors performed a retrospective analysis of IPLs of BAEPs in 93 patients who underwent intraoperative BAEP monitoring during MVD. Patients who did not have hearing loss were in Class A/B and those who had hearing loss were in Class C/D. RESULTS: Binary logistic regression analysis of independent IPL variables was performed. A maximum change in IPLs of Waves I-III and Waves I-V and on-skin change in IPLs of Waves I-V increases the odds of hearing loss. However, on adjusting the same variables for loss of response, change in IPLs did not increase the odds of hearing loss. CONCLUSIONS: Changes in IPL measurements did not increase the odds of postoperative hearing loss. This information might be helpful in evaluating the value of IPLs as alarm criteria during MVD to prevent hearing loss.
