A novel method in predicting immediate postoperative facial nerve function post acoustic neuroma excision.
To determine whether the percentage calculated by dividing the amplitude of postexcision direct facial nerve stimulus responses (at pontomedullary junction) by the amplitude of distal ipsilateral transcutaneous (stylomastoid region) maximal stimulus responses and response amplitude progression by increasing stimulus intensities have predictive value for determining normal or near-normal (House-Brackmann Grade 1 or 2) immediate postoperative facial nerve function.


METHODS
Intraoperative recordings of three muscle groups: 1) frontalis, 2) orbicularis oculi, and 3) orbicularis oris. Postexcision direct facial nerve stimulation at the pontomedullary junction and transcutaneous maximal facial nerve stimulation at the ipsilateral stylomastoid region and their associated response amplitudes were recorded.


METHODS
Tertiary referral center.


METHODS
Patients who underwent acoustic neuroma surgery from January 2004 to March 2006 with intraoperative facial nerve monitoring and an intact facial nerve after tumor excision were included. Recordings were available for 38 patients.


RESULTS
With a stimulus intensity of 0.3 mA at the root exit zone, there was an 81% positive predictive value in patients that exhibited a compound action potential of greater than 20% of maximum (sensitivity, 81%). This increased to 93% when the compound action potential was greater than 50% of maximum. When the amplitude increase was greater than 5 microV, there was a 77% positive predictive value (sensitivity, 87%).


CONCLUSIONS
The percentage of the response amplitude of direct facial nerve stimulation at the pontomedullary junction when compared with the maximum response amplitude of ipsilateral transcutaneous stimulation at the stylomastoid foramen is a good predictor of normal to near-normal immediate postoperative facial nerve function. Progression of amplitude response also seems to be a good predictor of normal to near-normal immediate postoperative facial nerve function.
Lin
Vincent Y W
VY
Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. vincent.lin@sunnybrook.ca
Houlden
David
D
Bethune
Allison
A
Nolan
Meghan
M
Pirouzmand
Farhad
F
Rowed
David
D
Nedzelski
Julian M
JM
Chen
Joseph M
JM
D000328:Adult; D000368:Aged; D004558:Electric Stimulation; D005154:Facial Nerve / Q000503:physiopathology*; D020220:Facial Nerve Injuries / Q000517:prevention & control; D005158:Facial Paralysis / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009464:Neuroma, Acoustic / Q000601:surgery*; D011237:Predictive Value of Tests; D016896:Treatment Outcome