title: Intraoperative electrophysiologic identification of the nervus intermedius.
abstract: OBJECTIVE
  Although enormous attention has been directed to the localization and preservation of the facial nerve in acoustic neuroma surgery, the nervus intermedius has largely been ignored. In this article, we describe a method for intraoperative electrophysiologic identification of the nervus intermedius.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  University hospital (tertiary care center).
  
  
  METHODS
  Thirty-three patients who underwent intraoperative facial nerve monitoring for various cerebellopontine angle procedures. Recording electrodes were placed in the orbicularis oculi and orbicularis oris muscles. A constant-voltage stimulator was used to stimulate both the facial nerve and the nervus intermedius.
  
  
  METHODS
  None.
  
  
  METHODS
  Electrophysiologic response after stimulation of the nervus intermedius.
  
  
  RESULTS
  Stimulation of the nervus intermedius produced long-latency, low-amplitude response recorded only on the orbicularis oris channel. The response had a mean threshold 0.4 V, a mean latency of 11.1 ms, and a mean amplitude of 11.1 microV, all significantly different from responses to stimulation the facial nerve.
  
  
  CONCLUSIONS
  Knowledge of electrophysiologic features of nervus intermedius stimulation can help protect the facial nerve during cerebellopontine angle surgery. The surgeon must recognize that stimulation of the nervus intermedius can cause electromyographic activity in the facial nerve monitoring channels, but the main trunk of the facial nerve may lie in entirely different location in the cerebellopontine angle.
authors.affiliation: Department of Physiology, Alexandria University School of Medicine, Alexandria, Egypt.
authors.forename: Yasmine A
authors.initials: YA
authors.lastname: Ashram
authors.forename: Robert K
authors.initials: RK
authors.lastname: Jackler
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Pitts
authors.forename: Charles D
authors.initials: CD
authors.lastname: Yingling
mesh_terms: D000293:Adolescent; D000328:Adult; D000344:Afferent Pathways / Q000503:physiopathology; D000368:Aged; D000370:Ageusia / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control; D001767:Blinking / Q000502:physiology; D002648:Child; D002814:Chorda Tympani Nerve / Q000503:physiopathology; D020209:Cranial Nerve Injuries / Q000503:physiopathology / Q000517:prevention & control*; D003391:Cranial Nerves / Q000503:physiopathology; D004423:Ear / Q000294:innervation; D004568:Electrodiagnosis; D004576:Electromyography; D005154:Facial Nerve / Q000503:physiopathology; D020220:Facial Nerve Injuries / Q000503:physiopathology / Q000517:prevention & control*; D005158:Facial Paralysis / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009301:Nasolacrimal Duct / Q000294:innervation; D009464:Neuroma, Acoustic / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control; D011379:Prognosis; D011930:Reaction Time / Q000502:physiology; D012189:Retrospective Studies; D012684:Sensory Thresholds / Q000502:physiology; D013666:Tears / Q000378:metabolism