Preservation of hearing in operations on acoustic tumors: an alternative to recording brain stem auditory evoked potentials.
The monitoring of auditory function by recording brain stem auditory evoked potentials in patients undergoing removal of acoustic tumors is hampered by the small amplitude of the brain stem auditory evoked potentials. Because several thousands of responses must be added, it takes several minutes to obtain an interpretable record. Recordings done directly from the exposed eighth nerve have much higher amplitudes, and, therefore, interpretable responses can be obtained after only a few responses have been added. However, it is difficult to place the recording electrode in an optimal position and the electrode may interfere with the removal of the tumor. In this report, we show that evoked potentials from the cochlear nucleus, which can be recorded by placing an electrode in the lateral recess of the fourth ventricle, have a large amplitude, and that the electrode placed in this way does not interfere with the removal of the tumor. This way of monitoring, therefore, yields interpretable responses within 15 to 20 seconds, or less, and makes it possible to detect injuries to the entire intracranial portion of the eighth nerve, just as brain stem auditory evoked potentials do, but 20 to 50 times faster.
Møller
A R
AR
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
Jho
H D
HD
Jannetta
P J
PJ
D000161:Acoustic Stimulation; D001933:Brain Stem / Q000503:physiopathology; D003056:Cochlear Nerve / Q000503:physiopathology; D004566:Electrodes; D004569:Electroencephalography / Q000295:instrumentation; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology*; D006313:Hearing Loss, Central / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D009464:Neuroma, Acoustic / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D011930:Reaction Time / Q000502:physiology; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D009435:Synaptic Transmission / Q000502:physiology; D000159:Vestibulocochlear Nerve / Q000503:physiopathology; D061285:Vestibulocochlear Nerve Injuries