Intraoperative facial motor evoked potential monitoring for pontine cavernous malformation resection

Ridzky Firmansyah Hardian MD, Tetsuya Goto MD, PhD, Yu Fujii MD, PhD, Kohei Kanaya MD, PhD, Tetsuyoshi Horiuchi MD, PhD, and Kazuhiro Hongo MD, PhD
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  • Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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OBJECTIVE

The aim of this study was to predict postoperative facial nerve function during pontine cavernous malformation surgery by monitoring facial motor evoked potentials (FMEPs).

METHODS

From 2008 to 2017, 10 patients with pontine cavernous malformations underwent total resection via the trans–fourth ventricle floor approach with FMEP monitoring. House-Brackmann grades and Karnofsky Performance Scale (KPS) scores were obtained pre- and postoperatively. The surgeries were performed using one of 2 safe entry zones into the brainstem: the suprafacial triangle and infrafacial triangle approaches. Six patients underwent the suprafacial triangle approach, and 4 patients underwent the infrafacial triangle approach. A cranial peg screw electrode was used to deliver electrical stimulation for FMEP by a train of 4 or 5 pulse anodal constant current stimulation. FMEP was recorded from needle electrodes on the ipsilateral facial muscles and monitored throughout surgery by using a threshold-level stimulation method.

RESULTS

FMEPs were recorded and analyzed in 8 patients; they were not recorded in 2 patients who had severe preoperative facial palsy and underwent an infrafacial triangle approach. Warning signs appeared in all patients who underwent the suprafacial triangle approach. However, after temporarily stopping the procedures, FMEP findings during surgery showed recovery of the thresholds. FMEPs in patients who underwent the infrafacial triangle approach were stable during the surgery. House-Brackmann grades were unchanged postoperatively in all patients. Postoperative KPS scores improved in 3 patients, decreased in 1, and remained the same in 6 patients.

CONCLUSIONS

FMEPs can be used to monitor facial nerve function during surgery for pontine cavernous malformations, especially when the suprafacial triangle approach is performed.

ABBREVIATIONS

CN = cranial nerve; FMEP = facial MEP; KPS = Karnofsky Performance Scale; MEP = motor evoked potential.

Figure from Minchev et al. (pp 150–158).

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