Evoked facial nerve EMG and brainstem auditory evoked potential monitoring in cerebellopontine angle tumor resection.
BACKGROUND
The preservation of normal nerve function or identification of nerve route is critical in some surgeries of cerebellopontine angle tumors. Over the last 5 years, intraoperative facial nerve electromyogram (EMG) and brainstem auditory evoked potential (BAEP) were applied for evaluation of facial nerve integrity and brainstem function in patients while undergoing resection of cerebellopontine angle (CPA) tumor. This report represents the retrospective analysis of our results.


METHODS
The inhalational anesthesia with 1-1.5% isoflurane in pure O2 was used. Muscle relaxation was maintained with continuous infusion of atracurium. The degree of muscle relaxation was aimed at a T4/T1 ratio of train-of-four response more than 20% of the adductus pollicis upon ulnar nerve stimulation at the wrist. In 236 patients suffering from CPA tumor without facial palsy, the EMG of the mentalis muscle ipisilateral to the tumor was obtained through stimulation of the facial nerve. The stimulation was applied with a nerve finder, which delivered an electrical stimulation of a single 2 mamp direct current. The EMG finding was compared with the clinical result. In 198 patients, BAEP was used to monitor the brainstem function during tumor resection. In case of intact hearing the BAEP was taken ipsilateral to the operation side and in case with total hearing loss contralateral BAEP to operation side was used. For BAEP stimulation, 90 db click sound stimulation with frequency of 11.26 Hz was applied to both ears. BAEP signals were obtained and recorded at the mastoid region of either side in reference to the vertex. The EMG and BAEP signals were recorded and saved to an evoked potential monitor.


RESULTS
In facial nerve EMG monitoring, there were two false positive and no false negative tests. Except for the two false positive tests, the postoperative clinical results in the other cases were compatible with the intraoperative facial nerve EMG findings. In BAEP monitoring, there were twenty-eight positive tests.


CONCLUSIONS
The low incidence of false negative test suggests that facial nerve EMG is valuable in detection of facial nerve function in CPA tumor resection. Intraoperative BAEP abnormality is possibly useful in identifying postoperative brainstem dysfunction.
Lin
C M
CM
Department of Anesthesiology, Chang-Gung Memorial Hospital, Taipei, Taiwan, R.O.C.
Hsu
J C
JC
Wu
R S
RS
Wu
K C
KC
Yu
C L
CL
Wu
H F
HF
Tan
P P
PP
D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D002528:Cerebellar Neoplasms / Q000601:surgery*; D002530:Cerebellopontine Angle; D004576:Electromyography; D005071:Evoked Potentials; D016057:Evoked Potentials, Auditory, Brain Stem; D005154:Facial Nerve / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies