title: Prognostic significance of intraoperative facial nerve stimulus thresholds.
abstract: OBJECTIVE
  Intraoperative facial nerve monitoring has reduced the incidence of facial nerve paralysis associated with acoustic neuroma surgery, but poor facial nerve outcomes continue to occur. Intraoperative prediction of facial nerve outcome would be advantageous in patient management and counseling. This study seeks to evaluate intraoperative facial nerve stimulus thresholds as a tool for predicting postoperative facial nerve outcome.
  
  
  METHODS
  This study is a prospective clinical study of the prognostic value of intraoperative stimulus thresholds.
  
  
  METHODS
  The study was performed at a tertiary referral center.
  
  
  METHODS
  There were 109 patients undergoing excision of acoustic neuromas included in this study.
  
  
  METHODS
  The minimum current required to stimulate the facial nerve at the brain stem was prospectively recorded after excision of the acoustic neuroma.
  
  
  METHODS
  Facial nerve outcome was evaluated by the House-Brackmann grade.
  
  
  RESULTS
  A statistically significant relationship was found between poor initial facial nerve outcome and higher stimulus thresholds. Long-term impaired facial function was also more common in the higher stimulus group compared to that of the lower stimulus groups.
  
  
  CONCLUSIONS
  Although these findings suggest that intraoperative stimulus thresholds have prognostic potential, other prognostic factors should also be considered and additional research is needed.
authors.affiliation: Department of Otolaryngology, New York University Medical Center, Belleview Hospital, New York University, New York, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Zeitouni
authors.forename: P E
authors.initials: PE
authors.lastname: Hammerschlag
authors.forename: N L
authors.initials: NL
authors.lastname: Cohen
mesh_terms: D004576:Electromyography; D005154:Facial Nerve / Q000601:surgery*; D006801:Humans; D016343:Monitoring, Intraoperative; D009464:Neuroma, Acoustic / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies