title: BAER suppression during posterior fossa dural opening.
abstract: BACKGROUND
  Intraoperative monitoring with brainstem auditory evoked responses (BAER) provides an early warning signal of potential neurological injury and may avert tissue damage to the auditory pathway or brainstem. Unexplained loss of the BAER signal in the operating room may present a dilemma to the neurosurgeon.
  
  
  METHODS
  This paper documents two patients who displayed a unique mechanism of suppression of the BAER apparent within minutes following dural opening for resection of a posterior fossa meningioma.
  
  
  RESULTS
  In two patients with anterior cerebellopontine angle and clival meningiomas, there was a significant deterioration of the BAER soon after durotomy but prior to cerebellar retraction and tumor removal. Intracranial structures in the posterior fossa lying between the tumor and dural opening were shifted posteriorly after durotomy.
  
  
  CONCLUSIONS
  We hypothesized that the cochlear nerve and vessels entering the acoustic meatus were compressed or stretched when subjected to tissue shift. This movement caused cochlear nerve dysfunction that resulted in BAER suppression. BAER was partially restored after the tumor was decompressed, dura repaired, and bone replaced. BAER was not suppressed following durotomy for removal of a meningioma lying posterior to the cochlear complex. Insight into the mechanisms of durotomy-induced BAER inhibition would allay the neurosurgeon's anxiety during the operation.
authors.affiliation: Norton Neuroscience Institute, Norton Healthcare, 210 East Gray Street, Suite 1102, Louisville, KY 40202, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Shields
authors.affiliation: Norton Neuroscience Institute, Norton Healthcare, 210 East Gray Street, Suite 1102, Louisville, KY 40202, USA.
authors.forename: Lisa B E
authors.initials: LB
authors.lastname: Shields
authors.affiliation: Impulse Monitoring Inc., 10420 Little Patuxent Parkway, Suite 250, Columbia, MD 21044, USA.
authors.forename: Yi Dan
authors.initials: YD
authors.lastname: Jiang
authors.affiliation: Norton Neuroscience Institute, Norton Healthcare, 210 East Gray Street, Suite 1102, Louisville, KY 40202, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Yao
authors.affiliation: Norton Neuroscience Institute, Norton Healthcare, 210 East Gray Street, Suite 1102, Louisville, KY 40202, USA.
authors.forename: Yi Ping
authors.initials: YP
authors.lastname: Zhang
authors.affiliation: Norton Neuroscience Institute, Norton Healthcare, 210 East Gray Street, Suite 1102, Louisville, KY 40202, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Sun
keywords: Brainstem auditory evoked responses; durotomy; internal auditory meatus; posterior fossa brain tumor