Brainstem auditory evoked potential monitoring: when is change in wave V significant?
BACKGROUND
The probability of hearing loss during cerebellopontine angle (CPA) surgery can be reduced by using brainstem auditory evoked potential (BAEP) intraoperative monitoring (IOM). A wave V latency prolongation of 1.0 milliseconds or amplitude decrement of greater than 50% is arbitrarily considered the point when damage to hearing occurs.


OBJECTIVE
To determine the accuracy of wave V changes in predicting hearing impairment.


METHODS
Patients undergoing BAEP IOM for surgery in the CPA region were evaluated. The greatest wave V latency and amplitude change was determined. Patients were divided into four groups depending on degree of change of wave V: Group 1 consisted of minimal change, whereas Group 4 was permanent loss of wave V. The frequency of hearing loss in each group was compared.


RESULTS
Data from 156 patients were reviewed. When all patients were analyzed, the frequency of hearing loss was not significantly different between the groups. When patients with CPA tumor were excluded, a significantly higher number of patients in Group 4 had hearing loss. Analysis of the patients with CPA tumor showed no difference in the frequency of hearing loss in any of the groups; even a large number (50%) of Group 1 patients had hearing impairment.


CONCLUSIONS
During brainstem auditory evoked potential intraoperative monitoring, the type of surgery is important when interpreting significance of changes of wave V. For non-cerebellopontine angle tumor surgery, hearing loss occurs usually only with permanent loss of wave V; much smaller changes may be important in cerebellopontine angle tumor surgery.
James
Michael L
ML
Department of Medicine (Neurology), Duke University Medical Center, Durham, NC 27710, USA.
Husain
Aatif M
AM
D000161:Acoustic Stimulation; D001306:Auditory Pathways / Q000503:physiopathology; D001933:Brain Stem / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D020295:Brain Stem Neoplasms / Q000473:pathology / Q000601:surgery; D003056:Cochlear Nerve / Q000293:injuries / Q000503:physiopathology* / Q000601:surgery; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods* / Q000592:standards / Q000639:trends; D009431:Neural Conduction / Q000502:physiology; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011930:Reaction Time / Q000502:physiology; D012189:Retrospective Studies