[Neurophysiologic intraoperative monitoring to preserve cranial nerve function in base of skull surgery].
BACKGROUND
Neurophysiologic intraoperative monitoring (NIM) has gone through a renaissance since the advent of computer technology. Currently, both motor and sensory cranial nerves, including the IInd and VIIIth cranial nerves, can be intraoperatively controlled by means of small and mobile systems.


METHODS
In order to estimate the value of NIM using the new generation of computer systems, we analyzed the records of 379 patients who underwent skull base surgery since 1996. These comprised NIM of the IInd, VIIth, VIIIth cranial nerves in most cases and of the IXth, Xth, XIth, and XIIth cranial nerves in selected cases.


RESULTS
Whereas 72% of these cases demonstrated changes in the recorded intraoperative NIM signals, only 29% of them gave evidence of either clinical or electrophysiological neural function alterations during the postoperative follow-up.


CONCLUSIONS
NIM is the only available system capable of providing the surgeon with instant intraoperative neural status-related feedback.
Schipper
J
J
Interdisziplinäres Zentrum für Schädelbasis- und Craniofaciale Chirurgie am Universitätsklinikum Freiburg. schipper@hno.ukl.uni-freiburg.de
Ridder
G J
GJ
Arapakis
I
I
Gellrich
N-C
NC
Spetzger
U
U
Maier
W
W
D003199:Computer Systems; D020209:Cranial Nerve Injuries / Q000503:physiopathology / Q000517:prevention & control*; D004566:Electrodes; D004596:Electroretinography / Q000295:instrumentation; D005072:Evoked Potentials, Auditory / Q000502:physiology; D019054:Evoked Potentials, Motor / Q000502:physiology; D005074:Evoked Potentials, Visual / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D009900:Optic Nerve / Q000503:physiopathology; D020221:Optic Nerve Injuries / Q000503:physiopathology / Q000517:prevention & control*; D010039:Otorhinolaryngologic Neoplasms / Q000503:physiopathology / Q000601:surgery*; D019095:Point-of-Care Systems; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control; D011930:Reaction Time / Q000502:physiology; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D019292:Skull Base Neoplasms / Q000503:physiopathology / Q000601:surgery*; D000159:Vestibulocochlear Nerve / Q000503:physiopathology; D061285:Vestibulocochlear Nerve Injuries