title: Value of multimodality monitoring using brainstem auditory evoked potentials and somatosensory evoked potentials in endoscopic endonasal surgery.
abstract: OBJECTIVE
  To evaluate the value of intraoperative neurophysiological monitoring (IONM) using brainstem auditory evoked potential (BAEP) and somatosensory evoked potential (SSEP) monitoring to predict and/or prevent postoperative neurological deficits during endoscopic endonasal surgery (EES).
  
  
  METHODS
  We retrospectively identified 138 consecutive patients who had BAEP monitoring in addition to SSEP monitoring during EES at our institution. We reviewed the postoperative clinical outcomes and neurophysiological changes independently.
  
  
  RESULTS
  The total of number of patients with any IONM changes was 10. The incidence of BAEP changes was 3.62%. The incidence of SSEP changes was 3.62% as well. One patient had changes in both BAEPs and SSEPs. Majority of the changes were observed during changes in mean arterial pressure (MAP) without any postoperative neurological deficits. There were two postoperative neurological deficits.
  
  
  CONCLUSIONS
  BAEPs and SSEPs provide unique information about integrity of brainstem function during EES procedures involving tumors in the and around clival region. We advocate a comprehensive multimodality approach to IONM during EESs including BAEPs and SSEPs depending on the location of the neural structures at risk.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA. thirumalapd@upmc.edu
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
authors.forename: Hemasree S
authors.initials: HS
authors.lastname: Kodavatiganti
authors.forename: Miguel
authors.initials: M
authors.lastname: Habeych
authors.forename: Kelley
authors.initials: K
authors.lastname: Wichman
authors.forename: Yue-fang
authors.initials: YF
authors.lastname: Chang
authors.forename: Paul
authors.initials: P
authors.lastname: Gardner
authors.forename: Carl
authors.initials: C
authors.lastname: Snyderman
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Crammond
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Balzer
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016343:Monitoring, Intraoperative / Q000379:methods*; D009296:Nasal Cavity / Q000502:physiology / Q000601:surgery*; D012189:Retrospective Studies