Facial Nerve Monitoring Parameters As a Predictor of Postoperative Facial Nerve Outcomes after Vestibular Schwannoma Resection

Objective: To evaluate whether the intraoperative stimulus threshold and response amplitude measurements from facial electromyography can predict facial nerve function at 1 year after vestibular schwannoma resection. Study Design: Prospective study. Setting: Tertiary academic center. Patients: Seventy-four consecutive vestibular schwannoma patients. Intervention: The minimal stimulus intensity (in milliamperes) and electromyographic response amplitude (in microvolts) were recorded during stimulation applied to the proximal facial nerve after vestibular schwannoma removal. Main Outcome Measure: Facial nerve outcomes at 1 year were evaluated using the House-Brackmann scale. Analysis was then performed to evaluate whether these electrophysiologic recordings and tumor size could predict facial nerve functional outcomes. Results: Of the 74 patients, 66 of 74 (89%) had House-Brackmann Grade I or II facial nerve function and 8 of 74 (11%) had House-Brackmann Grade III-VI function at 1 year after surgery. If standards were set for intraoperative minimal stimulus intensity of 0.05 mA or less and response amplitude of 240 μV or greater, the authors were able to predict a House-Brackmann Grade I or II outcome in 56 of 66 (85%) patients at 1 year after surgery. With these same electrophysiologic parameters, only 1 of 8 (12%) House-Brackmann Grade III-VI patients also met this standard and thus gave a false-positive result. Logistic regression analysis of the data showed that both a stimulus threshold of 0.05 mA or less and a response amplitude of 240 μV or greater predicted a House-Brackmann Grade I or II outcome with a 98% probability. However, stimulus threshold or response amplitude alone had a much lower probability of the same result. In addition, although tumor size was found to independently predict facial nerve outcomes at 1 year, it did not improve the ability to predict facial nerve function over a model using stimulus intensity and amplitude alone. Conclusion: Individually, minimal stimulus intensity or response amplitude was less successful in predicting long-term postoperative facial nerve function. However, if both parameters are considered together, the study demonstrates that they are good prognostic indicators for facial nerve function at 1 year after surgery.

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