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Intraoperative Monitoring

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Microvascular Decompression Surgery

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Abstract

This chapter provides an overview of the tests that constitute the tools in intraoperative neurophysiology of cranial nerves. The general introduction and equipment of monitoring are described. This chapter gives a practical presentation of each neurophysiological method regarding the following: (1) the principle on which it is based, (2) the methodology for stimulation and recording, (3) the intraoperative interpretation, and (4) the various types of anesthetics and their effects on neurophysiological monitoring. At the end of the chapter, a detailed example of the combined use of intraoperative monitoring for MVD surgery is discussed.

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References

  • Acevedo JC, Sindou M, Fischer C, Vial C. Microvascular decompression for the treatment of hemifacial spasm. Retrospective study of a consecutive series of 75 operated patients--electrophysiologic and anatomical surgical analysis. Stereotact Funct Neurosurg. 1997;68(1–4 Pt 1):260–5.

    CAS  PubMed  Google Scholar 

  • Acioly MA, Liebsch M, Carvalho CH, Gharabaghi A, Tatagiba M. Transcranial electrocortical stimulation to monitor the facial nerve motor function during cerebellopontine angle surgery. Neurosurgery. 2010;66:354–61; discussion 362.

    Article  PubMed  Google Scholar 

  • Adamec I, Grahovac G, Krbot Skoric M, Chudy D, Hajnsek S, Habek M. Tongue somatosensory-evoked potentials in microvascular decompression treated trigeminal neuralgia. Acta Neurol Belg. 2014;114:55–8.

    Article  PubMed  Google Scholar 

  • Akagami R, Dong CC, Westerberg BD. Localized transcranial electrical motor evoked potentials for monitoring cranial nerves in cranial base surgery. Neurosurgery. 2005;57:78–85; discussion 78–85.

    PubMed  Google Scholar 

  • Aramideh M, Ongerboer de Visser BW. Brainstem reflexes: electrodiagnostic techniques, physiology, normative data, and clinical applications. Muscle Nerve. 2002;26:14–30.

    Article  CAS  PubMed  Google Scholar 

  • Bennett MH, Jannetta PJ. Evoked potentials in trigeminal neuralgia. Neurosurgery. 1983;13:242–7.

    Article  CAS  PubMed  Google Scholar 

  • Chiappa KH. Evoked potentials in clinical medicine. Philadelphia: Lippincott Williams & Wilkins; 1990.

    Google Scholar 

  • Cosetti MK, Xu M, Rivera A, Jethanamest D, Kuhn MA, Beric A, et al. Intraoperative transcranial motor-evoked potential monitoring of the facial nerve during cerebellopontine angle tumor resection. J Neurol Surg B Skull Base. 2012;73:308–15.

    Article  PubMed Central  PubMed  Google Scholar 

  • Cruccu G, Leandri M, Feliciani M, Manfredi M. Idiopathic and symptomatic trigeminal pain. J Neurol Neurosurg Psychiatry. 1990;53:1034–42.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Deletis V, Urriza J, Ulkatan S, Fernandez-Conejero I, Lesser J, Misita D. The feasibility of recording blink reflexes under general anesthesia. Muscle Nerve. 2009;39:642–6.

    Article  PubMed  Google Scholar 

  • Dong CC, Akagami R, Westerberg B, Alkhani A, Kanaan I, Hassounah M. Intraoperative facial motor evoked potential monitoring with transcranial electrical stimulation during skull base surgery. Clin Neurophysiol. 2005;116(3):588–96.

    Article  PubMed  Google Scholar 

  • Eekhof JL, Aramideh M, Speelman JD, Devriese PP, De Ongerboer VBW. Blink reflexes and lateral spreading in patients with synkinesia after Bell’s palsy and in hemifacial spasm. Eur Neurol. 2000;43:141–6.

    Article  CAS  PubMed  Google Scholar 

  • Esteban A. A neurophysiological approach to brainstem reflexes. Blink reflex. Neurophysiol Clin. 1999;29:7–38.

    Article  CAS  PubMed  Google Scholar 

  • Fagade OO, Wastell DG. Trigeminal somatosensory evoked potentials: technical parameters, reliability and potential in clinical dentistry. J Dent. 1990;18:137–41.

    Article  CAS  PubMed  Google Scholar 

  • Fernandez-Conejero I, Ulkatan S, Sen C, Deletis V. Intra-operative neurophysiology during microvascular decompression for hemifacial spasm. Clin Neurophysiol. 2012;123:78–83.

    Article  CAS  PubMed  Google Scholar 

  • Fujiki M, Furukawa Y, Kamida T, Anan M, Inoue R, Abe T, Kobayashi H. Intraoperative corticomuscular motor evoked potentials for evaluation of motor function: a comparison with corticospinal D and I waves. J Neurosurg. 2006;104(1):85–92.

    Article  PubMed  Google Scholar 

  • Fukuda M, Oishi M, Takao T, Saito A, Fujii Y. Facial nerve motor-evoked potential monitoring during skull base surgery predicts facial nerve outcome. J Neurol Neurosurg Psychiatry. 2008;79:1066–70.

    Article  CAS  PubMed  Google Scholar 

  • Galloway GM, Nuwer MR, Lopez JR, Zamel KM. Intraoperative neurophysiologic monitoring. Cambridge: Cambridge University Press; 2010.

    Book  Google Scholar 

  • Habeych ME, Crammond DJ, Gardner P, Thirumala PD, Horowitz MB, Balzer JR. Intraoperative neurophysiological monitoring of microvascular decompression for glossopharyngeal neuralgia. J Clin Neurophysiol. 2014;31(4):337–43.

    Article  PubMed  Google Scholar 

  • Hai J, Pan QG. Experimental study on the correlation between abnormal muscle responses and F waves in hemifacial spasm. Neurol Res. 2007;29(6):553–6.

    Article  PubMed  Google Scholar 

  • Harper CM. Intraoperative cranial nerve monitoring. Muscle Nerve. 2004;29:339–51.

    Article  PubMed  Google Scholar 

  • Hatayama T, Mollar AR. Correlation between latency and amplitude of peak V in the brainstem auditory evoked potentials: intraoperative recordings in microvascular decompression operations. Acta Neurochir (Wien). 1998;140(7):681–7.

    Article  CAS  Google Scholar 

  • Ishikawa M, Namiki J, Takase M, Ohira T, Nakamura A, Toya S. Effect of repetitive stimulation on lateral spreads and F-waves in hemifacial spasm. J Neurol Sci. 1996;142:99–106.

    Article  CAS  PubMed  Google Scholar 

  • Ishikawa M, Ohira T, Namiki J, Kobayashi M, Takase M, Kawase T, et al. Electrophysiological investigation of hemifacial spasm after microvascular decompression: F waves of the facial muscles, blink reflexes, and abnormal muscle responses. J Neurosurg. 1997;86:654–61.

    Article  CAS  PubMed  Google Scholar 

  • Jo KW, Kim JW, Kong DS, Hong SH, Park K. The patterns and risk factors of hearing loss following microvascular decompression for hemifacial spasm. Acta Neurochir (Wien). 2011;153:1023–30.

    Article  Google Scholar 

  • Joo WI, Lee KJ, Park HK, Chough CK, Rha HK. Prognostic value of intra-operative lateral spread response monitoring during microvascular decompression in patients with hemifacial spasm. J Clin Neurosci. 2008;15:1335–9.

    Article  PubMed  Google Scholar 

  • Kalkman CJ, Been HD, Ongerboer de Visser BW. Intraoperative monitoring of spinal cord function. A review. Acta Orthop Scand. 1993;64:114–23.

    Article  CAS  PubMed  Google Scholar 

  • Kartush JM, Larouere MJ, Graham MD, Bouchard KR, Audet BV. Intraoperative cranial nerve monitoring during posterior skull base surgery. Skull Base Surg. 1991;1:85–92.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Kim CH, Kong DS, Lee JA, Kwan P. The potential value of the disappearance of the lateral spread response during microvascular decompression for predicting the clinical outcome of hemifacial spasms: a prospective study. Neurosurgery. 2010;67:1581–7; discussion 1587–8.

    Article  Google Scholar 

  • Kodama K, Javadi M, Seifert V, Szelenyi A. Conjunct SEP and MEP monitoring in resection of infratentorial lesions: lessons learned in a cohort of 210 patients. J Neurosurg. 2014;121:1453–61.

    Article  PubMed  Google Scholar 

  • Kong DS, Park K. Hemifacial spasm: a neurosurgical perspective. J Korean Neurosurg Soc. 2007;42(5):355–62.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kugelberg E. [Facial reflexes]. Brain. 1952;75:385–96.

    Article  CAS  PubMed  Google Scholar 

  • Lee SH, Song DG, Kim S, Lee JH, Kang DG. Results of auditory brainstem response monitoring of microvascular decompression: a prospective study of 22 patients with hemifacial spasm. Laryngoscope. 2009;119:1887–92.

    Article  PubMed  Google Scholar 

  • Legatt AD. Mechanisms of intraoperative brainstem auditory evoked potential changes. J Clin Neurophysiol. 2002;19:396–408.

    Article  PubMed  Google Scholar 

  • López JR. The use of evoked potentials in intraoperative neurophysiologic monitoring. Phys Med Rehabil Clin N Am. 2004;15(1):63–84.

    Article  PubMed  Google Scholar 

  • MacDonald DB. Safety of intraoperative transcranial electrical stimulation motor evoked potential monitoring. J Clin Neurophysiol. 2002;19:416–29.

    Article  PubMed  Google Scholar 

  • Macdonald DB, Skinner S, Shils J, Yingling C, American Society of Neurophysiological M. Intraoperative motor evoked potential monitoring – a position statement by the American Society of Neurophysiological Monitoring. Clin Neurophysiol. 2013;124:2291–316.

    Article  CAS  PubMed  Google Scholar 

  • Malcharek MJ, Landgraf J, Hennig G, Sorge O, Aschermann J, Sablotzki A. Recordings of long-latency trigeminal somatosensory-evoked potentials in patients under general anaesthesia. Clin Neurophysiol. 2011;122:1048–54.

    Article  PubMed  Google Scholar 

  • Markand ON, Lee BI, Warren C, Stoelting RK, King RD, Brown JW, et al. Effects of hypothermia on brainstem auditory evoked potentials in humans. Ann Neurol. 1987;22:507–13.

    Article  CAS  PubMed  Google Scholar 

  • Matthies C, Raslan F, Schweitzer T, Hagen R, Roosen K, Reiners K. Facial motor evoked potentials in cerebellopontine angle surgery: technique, pitfalls and predictive value. Clin Neurol Neurosurg. 2011;113:872–9.

    Article  PubMed  Google Scholar 

  • Merton PA, Morton HB. Stimulation of the cerebral cortex in the intact human subject. Nature. 1980;285(5762):227.

    Article  CAS  PubMed  Google Scholar 

  • Minahan RE, Mandir AS. Neurophysiologic intraoperative monitoring of trigeminal and facial nerves. J Clin Neurophysiol. 2011;28:551–65.

    Article  PubMed  Google Scholar 

  • Mishler ET, Smith PG. Technical aspects of intraoperative monitoring of lower cranial nerve function. Skull Base Surg. 1995;5:245–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Moller AR. Interaction between the blink reflex and the abnormal muscle response in patients with hemifacial spasm: results of intraoperative recordings. J Neurol Sci. 1991;101(1):114–23.

    Article  CAS  PubMed  Google Scholar 

  • Moller AR. Intraoperative neurophysiologic monitoring. Am J Otol. 1995;16:115–7.

    Article  CAS  PubMed  Google Scholar 

  • Moller AR. Intraoperative neurophysiological monitoring. 3rd ed. New York: Springer-Verlag New York Inc; 2011.

    Book  Google Scholar 

  • Moller AR, Jannetta PJ. Physiological abnormalities in hemifacial spasm studied during microvascular decompression operations. Exp Neurol. 1986;93:584–600.

    Article  CAS  PubMed  Google Scholar 

  • Moller AR, Jannetta PJ. Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm. J Neurosurg. 1987;66:681–5.

    Article  CAS  PubMed  Google Scholar 

  • Møller AR, Møller MB. Does intraoperative monitoring of auditory evoked potentials reduce incidence of hearing loss as a complication of microvascular decompression of cranial nerves? Neurosurgery. 1989;24(2):257–63.

    Article  PubMed  Google Scholar 

  • Motoyama Y, Kawaguchi M, Yamada S, Nakagawa I, Nishimura F, Hironaka Y, Park YS, Hayashi H, Abe R, Nakase H. Evaluation of combined use of transcranial and direct cortical motor evoked potential monitoring during unruptured aneurysm surgery. Neurol Med Chir (Tokyo). 2011;51(1):15–22.

    Article  Google Scholar 

  • Mourisse J, Lerou J, Zwarts M, Booij L. Electromyographic assessment of blink reflexes correlates with a clinical scale of depth of sedation/anaesthesia and BIS during propofol administration. Acta Anaesthesiol Scand. 2004;48:1174–9.

    Article  CAS  PubMed  Google Scholar 

  • Nelson KR, Vasconez HC. Nerve transection without neurotonic discharges during intraoperative electromyographic monitoring. Muscle Nerve. 1995;18(2):236–8.

    Article  CAS  PubMed  Google Scholar 

  • Oge AE, Yayla V, Demir GA, Eraksoy M. Excitability of facial nucleus and related brain-stem reflexes in hemifacial spasm, post-facial palsy synkinesis and facial myokymia. Clin Neurophysiol. 2005;116:1542–54.

    Article  PubMed  Google Scholar 

  • Oikawa T, Matsumoto M, Sasaki T, Kodama N. Experimental study of medullary trigeminal evoked potentials: development of a new method of intraoperative monitoring of the medulla oblongata. J Neurosurg. 2000;93:68–76.

    Article  CAS  PubMed  Google Scholar 

  • Onofrj M, Basciani M, Fulgente T, Bazzano S, Malatesta G, Curatola L. Maps of Somatosensory Evoked Potentials (SEPs) to mechanical (tapping) stimuli: comparison with P14, N20, P22, N30 of electrically elicited SEPs. Electroencephalogr Clin Neurophysiol. 1990;77:314–9.

    Article  CAS  PubMed  Google Scholar 

  • Polo G, Fischer C, Sindou MP, Marneffe V. Brainstem auditory evoked potential monitoring during microvascular decompression for hemifacial spasm: intraoperative brainstem auditory evoked potential changes and warning values to prevent hearing loss--prospective study in a consecutive series of 84 patients. Neurosurgery. 2004;54(1):97–104; discussion 104−6.

    Article  PubMed  Google Scholar 

  • Sala F, Manganotti P, Tramontano V, Bricolo A, Gerosa M. Monitoring of motor pathways during brain stem surgery: what we have achieved and what we still miss? Neurophysiol Clin. 2007;37(6):399–406.

    Article  CAS  PubMed  Google Scholar 

  • Samii M, Gunther T, Iaconetta G, Muehling M, Vorkapic P, Samii A. Microvascular decompression to treat hemifacial spasm: long-term results for a consecutive series of 143 patients. Neurosurgery. 2002;50:712–8; discussion 718–9.

    Article  PubMed  Google Scholar 

  • Sanes JN, Foss JA, Ison JR. Conditions that affect the thresholds of the components of the eyeblink reflex in humans. J Neurol Neurosurg Psychiatry. 1982;45(6):543–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Sarnthein J, Hejrati N, Neidert MC, Huber AM, Krayenbühl N. Facial nerve motor evoked potentials during skull base surgery to monitor facial nerve function using the threshold-level method. Neurosurg Focus. 2013;34(3):E7.

    Article  PubMed  Google Scholar 

  • Schlake HP, Goldbrunner R, Milewski C, Siebert M, Behr R, Riemann R, et al. Technical developments in intra-operative monitoring for the preservation of cranial motor nerves and hearing in skull base surgery. Neurol Res. 1999;21:11–24.

    Article  CAS  PubMed  Google Scholar 

  • Schlake HP, Milewski C, Goldbrunner RH, Kindgen A, Riemann R, Helms J, et al. Combined intra-operative monitoring of hearing by means of auditory brainstem responses (ABR) and transtympanic electrocochleography (ECochG) during surgery of intra- and extrameatal acoustic neurinomas. Acta Neurochir (Wien). 2001;143:985–95; discussion 995–6.

    Article  CAS  Google Scholar 

  • Sekula Jr RF, Bhatia S, Frederickson AM, Jannetta PJ, Quigley MR, Small GA, Breisinger R. Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis. Neurosurg Focus. 2009;27(4):E10.

    Article  Google Scholar 

  • Sindou MP. Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring. Acta Neurochir (Wien). 2005;147(10):1019–26; discussion 1026.

    Article  CAS  Google Scholar 

  • Singh R, Husain AM. Neurophysiologic intraoperative monitoring of the glossopharyngeal and vagus nerves. J Clin Neurophysiol. 2011;28:582–6.

    Article  PubMed  Google Scholar 

  • Society ACN. Guideline 9C: guidelines on short-latency auditory evoked potentials. Am J Electroneurodiagnostic Technol. 2006;46(3):275–86.

    Google Scholar 

  • Stechison MT, Kralick FJ. The trigeminal evoked potential: Part I. Long-latency responses in awake or anesthetized subjects. Neurosurgery. 1993;33:633–8.

    Article  CAS  PubMed  Google Scholar 

  • Thirumala PD, Shah AC, Nikonow TN, Habeych ME, Balzer JR, Crammond DJ, et al. Microvascular decompression for hemifacial spasm: evaluating outcome prognosticators including the value of intraoperative lateral spread response monitoring and clinical characteristics in 293 patients. J Clin Neurophysiol. 2011;28:56–66.

    Article  PubMed  Google Scholar 

  • Valls-Sole J, Tolosa ES. Blink reflex excitability cycle in hemifacial spasm. Neurology. 1989;39:1061–6.

    Article  CAS  PubMed  Google Scholar 

  • Vriens JP, Pasman JW. Assessment of trigeminal nerve function by means of short-latency somatosensory evoked potentials after microneurosurgical repair. J Craniomaxillofac Surg. 1994;22:156–62.

    Article  CAS  PubMed  Google Scholar 

  • Wang AD, Costa e Silva I, Symon L, Jewkes D. The effects of halothane on somatosensory and flash visual evoked potentials during operations. Neurol Res. 1985;7:58–62.

    Article  PubMed  Google Scholar 

  • Wedekind C, Klug N. Nasal muscle F-wave for peri- and intraoperative diagnosis of facial nerve function. Electromyogr Clin Neurophysiol. 1998;38:481–90.

    CAS  PubMed  Google Scholar 

  • Wedekind C, Klug N. Assessment of facial nerve function in acoustic tumor disease by nasal muscle F waves and transcranial magnetic stimulation. Muscle Nerve. 2000;23:58–62.

    Article  CAS  PubMed  Google Scholar 

  • Wedekind C, Klug N. Facial F wave recording: a novel and effective technique for extra- and intraoperative diagnosis of facial nerve function in acoustic tumor disease. Otolaryngol Head Neck Surg. 2003;129:114–20.

    Article  PubMed  Google Scholar 

  • Wedekind C, Stauten W, Klug N. A normative study on human facial F waves. Muscle Nerve. 2001;24:900–4.

    Article  CAS  PubMed  Google Scholar 

  • Yang M, Zheng X, Ying T, Zhu J, Zhang W, Yang X, et al. Combined intraoperative monitoring of abnormal muscle response and Z-L response for hemifacial spasm with tandem compression type. Acta Neurochir (Wien). 2014;156:1161–6; discussion 1166.

    Article  Google Scholar 

  • Ying TT, Li ST, Zhong J, Li XY, Wang XH, Zhu J. The value of abnormal muscle response monitoring during microvascular decompression surgery for hemifacial spasm. Int J Surg. 2011;9:347–51.

    Article  PubMed  Google Scholar 

  • Ying T, Thirumala P, Chang Y, Habeych M, Crammond D, Balzer J. Emprical factors associated with Brainstem auditory evoked potential monitoring during microvascular decompression for hemifacial spasm and its correlation to hearing loss. Acta Neurochir (Wien). 2014;156:571–5.

    Article  Google Scholar 

  • Zheng X, Hong W, Tang Y, Ying T, Wu Z, Shang M, et al. Discovery of a new waveform for intraoperative monitoring of hemifacial spasms. Acta Neurochir (Wien). 2012;154:799–805.

    Article  Google Scholar 

  • Zouridakis G, Papanicolaou AC. A concise guide to intraoperative monitoring. Hoboken: CRC Press; 2000.

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, XinHua Hospital, Shanghai Jiao Tong University School of Medicine. The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai, China

    Shi-Ting Li & Ting-Ting Ying

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  1. Shi-Ting Li
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  2. Ting-Ting Ying
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Editors and Affiliations

  1. Shanghai, China

    Shi-Ting Li

  2. Dept. Neurosurgery, XinHua Hospital, Shanghai, China

    Jun Zhong

  3. UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania, USA

    Raymond F. Sekula, Jr.

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Li, ST., Ying, TT. (2016). Intraoperative Monitoring. In: Li, ST., Zhong, J., Sekula, Jr., R. (eds) Microvascular Decompression Surgery. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-7366-9_12

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