title: Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery.
abstract: BACKGROUND
  Preservation of facial nerve function is one of the most important goals in acoustic neuroma surgery. We have been using intraoperative continuous monitoring of evoked facial nerve electromyograms (EMGs) since 1997 in acoustic neuroma surgery. We therefore investigated surgically treated patients to clarify the usefulness of this monitoring, and to determine safety criteria for preserving facial nerve function.
  
  
  METHODS
  This intraoperative continuous monitoring of evoked facial nerve EMG is a method for checking the EMG evoked by continuous direct electrical stimulation of the facial nerve during tumor excision. The greatest advantage of this method is the ability to identify changes in EMG in real time. We retrospectively investigated 216 patients with surgically treated acoustic neuroma to identify correlations between parameters in this monitoring and postoperative facial nerve function immediately and 1 year after surgery.
  
  
  RESULTS
  In these patients, the functional preservation rate of the facial nerve (House and Brackmann grade 1 or 2 at 1 year after surgery) was 98.6% with a 98.2% mean tumor resection rate. Amplitude preservation ratio correlated significantly with facial nerve function both immediately and 1 year after surgery. To avoid severe facial nerve palsy, a warning criterion of amplitude preservation ratio >50% appears useful.
  
  
  CONCLUSIONS
  Postoperative course of facial nerve function appears predictable using intraoperative continuous monitoring of evoked facial nerve EMGs. This monitoring is useful to increase the tumor excision rate while avoiding severe postoperative facial nerve palsy in acoustic neuroma surgery.
authors.affiliation: Department of Neurosurgery and Stroke Center, Tokyo Metropolitan Police Hospital, 4-22-1, Nakano, Nakano-Ku, Tokyo, 164-0001, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Amano
authors.forename: Michihiro
authors.initials: M
authors.lastname: Kohno
authors.forename: Osamu
authors.initials: O
authors.lastname: Nagata
authors.forename: Makoto
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Shigeo
authors.initials: S
authors.lastname: Sora
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sato
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004576:Electromyography / Q000379:methods* / Q000639:trends; D005154:Facial Nerve / Q000098:blood supply / Q000502:physiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods* / Q000639:trends; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D000159:Vestibulocochlear Nerve / Q000473:pathology / Q000601:surgery*; D055815:Young Adult