Intraoperative facial motor evoked potential monitoring for pontine cavernous malformation resection

Restricted access

 

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.
Article Information

Contributor Notes

Correspondence Tetsuya Goto: Shinshu University School of Medicine, Matsumoto, Japan. tegotou@shinshu-u.ac.jp.INCLUDE WHEN CITING Published online January 11, 2019; DOI: 10.3171/2018.8.JNS181199.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Headings
References
  • 1

    Acioly MALiebsch Mde Aguiar PHPTatagiba M: Facial nerve monitoring during cerebellopontine angle and skull base tumor surgery: a systematic review from description to current success on function prediction. World Neurosurg 80:e271e3002013

    • Search Google Scholar
    • Export Citation
  • 2

    Akagami RDong CCJWesterberg BD: Localized transcranial electrical motor evoked potentials for monitoring cranial nerves in cranial base surgery. Neurosurgery 57 (1 Suppl):78852005

    • Search Google Scholar
    • Export Citation
  • 3

    Bogucki JGielecki JCzernicki Z: The anatomical aspects of a surgical approach through the floor of the fourth ventricle. Acta Neurochir (Wien) 139:101410191997

    • Search Google Scholar
    • Export Citation
  • 4

    Calancie BMolano MR: Alarm criteria for motor-evoked potentials: what’s wrong with the "presence-or-absence" approach? Spine (Phila Pa 1976) 33:4064142008

    • Search Google Scholar
    • Export Citation
  • 5

    Dong CCJMacdonald DBAkagami RWesterberg BAlkhani AKanaan I: Intraoperative facial motor evoked potential monitoring with transcranial electrical stimulation during skull base surgery. Clin Neurophysiol 116:5885962005

    • Search Google Scholar
    • Export Citation
  • 6

    François PBen Ismail MHamel OBataille BJan MVelut S: Anterior transpetrosal and subtemporal transtentorial approaches for pontine cavernomas. Acta Neurochir (Wien) 152:132113292010

    • Search Google Scholar
    • Export Citation
  • 7

    Fukuda MOishi MTakao TSaito AFujii Y: Facial nerve motor-evoked potential monitoring during skull base surgery predicts facial nerve outcome. J Neurol Neurosurg Psychiatry 79:106610702008

    • Search Google Scholar
    • Export Citation
  • 8

    Goto TMuraoka HKodama KHara YYako THongo K: Intraoperative monitoring of motor evoked potential for the facial nerve using a cranial peg-screw electrode and a "threshold-level" stimulation method. Skull Base 20:4294342010

    • Search Google Scholar
    • Export Citation
  • 9

    Gross BABatjer HHAwad IABendok BRDu R: Brainstem cavernous malformations: 1390 surgical cases from the literature. World Neurosurg 80:89932013

    • Search Google Scholar
    • Export Citation
  • 10

    Kalani MYSYagmurlu KMartirosyan NLCavalcanti DDSpetzler RF: Approach selection for intrinsic brainstem pathologies. J Neurosurg 125:159616072016

    • Search Google Scholar
    • Export Citation
  • 11

    Kobayashi SSugita KTanaka YKyoshima K: Infratentorial approach to the pineal region in the prone position: Concorde position. Technical note. J Neurosurg 58:1411431983

    • Search Google Scholar
    • Export Citation
  • 12

    Kyoshima KKobayashi SGibo HKuroyanagi T: A study of safe entry zones via the floor of the fourth ventricle for brain-stem lesions. Report of three cases. J Neurosurg 78:9879931993

    • Search Google Scholar
    • Export Citation
  • 13

    Matsushima TInoue TInamura TNatori YIkezaki KFukui M: Transcerebellomedullary fissure approach with special reference to methods of dissecting the fissure. J Neurosurg 94:2572642001

    • Search Google Scholar
    • Export Citation
  • 14

    Murata THoriuchi THanaoka YMuraoka HGoto TIto K: "Kissing" brainstem cavernous angiomas removed using a trans-fourth ventricular floor approach—case report. Neurol Med Chir (Tokyo) 51:7247272011

    • Search Google Scholar
    • Export Citation
  • 15

    Saito NSasaki TChikui EYuyama RKirino T: Anterior transpetrosal approach for pontine cavernous angioma—case report. Neurol Med Chir (Tokyo) 42:2722742002

    • Search Google Scholar
    • Export Citation
  • 16

    Sala FManganotti PTramontano VBricolo AGerosa M: Monitoring of motor pathways during brain stem surgery: what we have achieved and what we still miss? Neurophysiol Clin 37:3994062007

    • Search Google Scholar
    • Export Citation
  • 17

    Watanabe KWatanabe TTakahashi ASaito NHirato MSasaki T: Transcranial electrical stimulation through screw electrodes for intraoperative monitoring of motor evoked potentials. Technical note. J Neurosurg 100:1551602004

    • Search Google Scholar
    • Export Citation
  • 18

    Zhou HHKelly PJ: Transcranial electrical motor evoked potential monitoring for brain tumor resection. Neurosurgery 48:107510812001

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 56 56 56
Full Text Views 12 12 12
PDF Downloads 42 42 42
EPUB Downloads 0 0 0
PubMed
Google Scholar