title: Train time as a quantitative electromyographic parameter for facial nerve function in patients undergoing surgery for vestibular schwannoma.
abstract: OBJECTIVE
  The authors describe a quantitative electromyographic (EMG) parameter for intraoperative monitoring of facial nerve function during vestibular schwannoma removal. This parameter is based on the automated detection of A trains, an EMG pattern that is known to be associated with postoperative facial nerve paresis.
  
  
  METHODS
  For this study, 40 patients were examined. During the entire operative procedure, free-running EMG signals were recorded in muscles targeted by the facial nerve. A software program specifically designed for this purpose was used to analyze these continuous recordings offline. By automatically adding up time intervals during which A trains occurred, a quantitative parameter was calculated, which was named "train time." A strong correlation between the length of train time (measured in seconds) and deterioration of postoperative facial nerve function was demonstrated. Certain consecutive safety thresholds at 0.5 and 10 seconds were defined. Their transgression reliably indicated postoperative facial nerve paresis. At less than a 10-second train time, discrete worsening, and at more than 10 seconds, profound deterioration of facial nerve function can be anticipated.
  
  
  CONCLUSIONS
  Train time as a quantitative parameter was shown to be a reliable indicator of facial nerve paresis after surgery for vestibular schwannoma.
authors.affiliation: Department of Neurosurgery, University of Halle-Wittenberg, Halle, Germany. julian.prell@medizin.uni-halle.de
authors.forename: Julian
authors.initials: J
authors.lastname: Prell
authors.forename: Stefan
authors.initials: S
authors.lastname: Rampp
authors.forename: Johann
authors.initials: J
authors.lastname: Romstöck
authors.forename: Rudolf
authors.initials: R
authors.lastname: Fahlbusch
authors.forename: Christian
authors.initials: C
authors.lastname: Strauss
mesh_terms: D000328:Adult; D000368:Aged; D004576:Electromyography; D005154:Facial Nerve / Q000503:physiopathology*; D005158:Facial Paralysis / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009464:Neuroma, Acoustic / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D011379:Prognosis; D011930:Reaction Time / Q000502:physiology; D012016:Reference Values; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted; D012984:Software