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Christian Strauss, Barbara Bischoff, Mandana Neu, Michael Berg, Rudolf Fahlbusch and Johann Romstöck

T he prognostic value of BAEP monitoring during acoustic neuroma surgery for hearing preservation is well recognized. Stable waves during surgery, in particular Wave V, indicate hearing preservation; abrupt loss and progressive irreversible loss of these waves are both associated with anacusis. 7, 14, 15, 18, 19, 30 Gradual reversible loss, which is described as a single or repeated transient absence of wave components ( Fig. 1 ) carries a considerable risk for postoperative hearing fluctuation and delayed hearing loss. 19, 28 In a previously published

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Johann Romstöck, Christian Strauss and Rudolf Fahlbusch

surgery for acoustic neuromas, EMG neuromonitoring has become a routine tool used to identify and protect the seventh cranial nerve; however, additional postoperative facial paresis has been reported in 10 to 27% of cases, especially following excision of large tumors. 7, 18, 19, 28, 29, 31 The rate of anatomical and functional preservation of the facial nerve was significantly lower in the era before standard EMG monitoring was applied routinely. 10, 29 Electrical stimulation of the facial nerve during removal of large acoustic neuromas has been widely used for longer

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Christian Strauss, Julian Prell, Stefan Rampp and Johann Romstöck

Department of Neurosurgery, University of Erlangen-Nuremberg, Germany, in honor of his 65th birthday. References 1 Anderson DE , Leonetti J , Wind JJ , Cribari D , Fahey K : Resection of large vestibular schwannomas: facial nerve preservation in the context of surgical approach and patient-assessed outcome . J Neurosurg 102 : 643 – 649 , 2005 2 Anonymous : Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery

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Christian Strauss, Johann Romstöck, Christopher Nimsky and Rudolf Fahlbusch

function during removal of acoustic neuromas. Use of monopolar constant-voltage stimulation and EMG. J Neurosurg 61 : 757 – 760 , 1984 Møller AR, Jannetta PJ: Preservation of facial function during removal of acoustic neuromas. Use of monopolar constant-voltage stimulation and EMG. J Neurosurg 61: 757–760, 1984 18. Newton HB , Miner ME : “One-and-a-half” syndrome after a resection of a midline cerebellar astrocytoma: case report and discussion of the literature. Neurosurgery 29 : 768 – 772 , 1991 Newton HB

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Julian Prell, Stefan Rampp, Johann Romstöck, Rudolf Fahlbusch and Christian Strauss

, 2005 2 Anonymous : Acoustic neuroma . Consens Statement 9 : 1 – 24 , 1982 3 Ciric I , Zhao JC , Rosenblatt S , Wiet R , O'Shaughnessy B : Suboccipital retrosigmoid approach for removal of vestibular schwannomas: facial nerve function and hearing preservation . Neurosurgery 56 : 560 – 570 , 2005 4 Darrouzet V , Hilton M , Pinder D , Wang JL , Guerin J , Bebear JP : Prognostic value of the blink reflex in acoustic neuroma surgery . Otolaryngol Head Neck Surg 127 : 153 – 157 , 2002 5 Delgado TE , Bucheit WA

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Christian Strauss, Barbara Bischoff, Johann Romstöck, Jens Rachinger, Stefan Rampp and Julian Prell

completely removed (Cases 24 and 25). Hearing was classified according to the guidelines of the Committee on Hearing and Equilibrium for the Evaluation of Hearing Preservation in Acoustic Neuroma of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. 1 Hearing Classes A and B were documented in 7 patients each, Class C in 4, and D in 9 patients. Four patients presented with deafness. Based on the HB scale, preoperative facial nerve function was classified as Grade I in 21 patients, Grade II in 8, and Grade III in 2 patients ( Table 1 ). 9 Other