Direct cochlear nerve stimulation monitoring through evoked muscle responses during retrosigmoid vestibular schwannoma resection surgery: technical note

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  • 1 Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne;
  • | 2 Avaton Surgical Group, Genolier Spine Care Center, Swiss Medical Network, Genolier;
  • | 3 Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne; and
  • | 4 Department of ENT and Head and Neck Surgery, University Hospital of Lausanne and University of Lausanne, Switzerland
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OBJECTIVE

Cochlear nerve preservation during surgery for vestibular schwannoma (VS) may be challenging. Brainstem auditory evoked potentials and cochlear compound nerve action potentials have clearly shown their limitations in surgeries for large VSs. In this paper, the authors report their preliminary results after direct electrical intraoperative cochlear nerve stimulation and recording of the postauricular muscle response (PAMR) during resection of large VSs.

METHODS

The details for the electrode setup, stimulation, and recording parameters are provided. Data of patients for whom PAMR was recorded during surgery were prospectively collected and analyzed.

RESULTS

PAMRs were recorded in all patients at the ipsilateral vertex-earlobe scalp electrode, and in 90% of the patients they were also observed in the contralateral electrode. The optimal stimulation intensity was found to be 1 mA at 1 Hz, with a good cochlear response and an absent response from other nerves. At that intensity, the ipsilateral cochlear response had an initial peak at a mean (± SEM) latency of 11.6 ± 1.5 msec with an average amplitude of 14.4 ± 5.4 µV. One patient experienced a significant improvement in his audition, while that of the other patients remained stable.

CONCLUSIONS

PAMR monitoring may be useful in mapping the position and trajectory of the cochlear nerve to enable hearing preservation during surgery.

ABBREVIATIONS

BAEP = brainstem auditory evoked potential; CNAP = cochlear compound nerve action potential; EMG = electromyography; MFN = medial facial nucleus; PAMR = postauricular muscle response; VS = vestibular schwannoma.

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