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Prediction of facial nerve function following acoustic neuroma resection using intraoperative facial nerve stimulation
Author(s) -
Silverstein Herbert,
Willcox Md Thomas O.,
Rosenberg Seth I.,
Seidman Michael D.
Publication year - 1994
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.5541040506
Subject(s) - facial nerve , medicine , acoustic neuroma , facial muscles , neuroma , anesthesia , surgery , electromyography , anatomy , physical medicine and rehabilitation
Methods of monitoring the facial nerve during posterior fossa surgery continue to evolve. In an effort to predict acute and final facial nerve function following acoustic neuroma resection, the lowest current applied to the facial nerve at the brainstem necessary to elicit facial muscle response was measured using strain gauge and electromyographic facial nerve monitors. A retrospective analysis of 121 patients who had undergone acoustic neuroma surgery was performed. Sixty‐five patients had intraoperative facial nerve monitoring and 44 had sufficient data for inclusion in this study. The acute and final facial nerve functions, according to the House‐Brackmann classification, were assessed with regard to intraoperative stimulation‐current thresholds. Nineteen of 20 patients who required 0.10 mA or less to elicit a facial muscle response had a House‐Brackmann grade I facial nerve outcome. The upper limit of the 95% confidence interval of stimulation threshold for patients with a final grade I facial nerve function is 0.17 mA. All of the patients in this study, with stimulation thresholds ranging up to 0.84 mA, had a final grade III or better result. A poor outcome in our series, a final grade III facial nerve function, is best predicted by a poor acute result, specifically an acute grade VI A facial nerve function. We suggest that it is possible to predict the facial nerve function based on intraoperative threshold testing.