Electrode Alternative for Eighth Nerve Monitoring During Vestibular Schwannoma Resection

2020 ◽  
Author(s):  
Luis A. Antezana ◽  
Matthew L. Carlson ◽  
Ernest M. Hoffman ◽  
Roberto A. Cueva ◽  
Jamie J. Van Gompel
Keyword(s):  
Vestibular Schwannoma ◽  
Nerve Monitoring ◽  
Eighth Nerve

Developing Intraoperative Cochlear Nerve Monitoring during Vestibular Schwannoma Surgery

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
A. Kasbekar ◽  
Y. Tam ◽  
R. Carlyon ◽  
J. Deeks ◽  
N. Donnelly ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Cochlear Nerve ◽  
Nerve Monitoring

Intraoperative Cochlear Nerve Monitoring in Vestibular Schwannoma Surgery – Does It Really Affect Hearing Outcome?

2007 ◽  
Vol 13 (1) ◽  
pp. 58-64 ◽  
Author(s):  
Enrico Piccirillo ◽  
Harukazu Hiraumi ◽  
Masashi Hamada ◽  
Alessandra Russo ◽  
Alessandro De Stefano ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Cochlear Nerve ◽  
Nerve Monitoring ◽  
Hearing Outcome

Our Experience With Facial Nerve Monitoring in Vestibular Schwannoma Surgery Under Partial Neuromuscular Blockade

2015 ◽  
Vol 66 (4) ◽  
pp. 192-198
Author(s):  
Jorge Vega-Céliz ◽  
Emili Amilibia-Cabeza ◽  
José Prades-Martí ◽  
Nuria Miró-Castillo ◽  
Marta Pérez-Grau ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Neuromuscular Blockade ◽  
Vestibular Schwannoma ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Partial Neuromuscular Blockade

Intraoperative Facial Nerve Monitoring (IFNM) Predicts Facial Nerve Outcome after Resection of Vestibular Schwannoma

1998 ◽  
Vol 140 (3) ◽  
pp. 235-243 ◽  
Author(s):  
S.B. Sobottka ◽  
G. Schackert ◽  
S.A. May ◽  
M. Wiegleb ◽  
G. Reiß
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring

Hearing Preservation after Acoustic Neuroma Surgery with Intraoperative Direct Eighth Cranial Nerve Monitoring: Part II. A Classification of Results

1986 ◽  
Vol 95 (3_part_1) ◽  
pp. 285-291 ◽  
Author(s):  
Herbert Silverstein ◽  
Alan Mcdaniel ◽  
Horace Norrell
Keyword(s):  
Intraoperative Monitoring ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Class Iii ◽  
Tumor Removal ◽  
Eighth Cranial Nerve ◽  
Nerve Monitoring ◽  
Eighth Nerve ◽  
Auditory Evoked Response ◽  
Acoustic Neuromas

Since the advent of brainstem auditory evoked response audiometry and computerized tomography, small acoustic neuromas are more frequently found. Often the patient has serviceable hearing, which we would like to preserve during complete tumor removal. Since 1978, sixteen patients with acoustic neuromas have been operated upon through the retrosigmoid suboccipital approach, with the goal of hearing preservation. In 1983, we began using intraoperative direct eighth nerve monitoring, which produced a rapid assessment of cochlear nerve function during the excision of small acoustic neuromas. The tumors varied in size from intracanalicular lesions to one lesion with a 3.0 cm protrusion medial to the porus acousticus. In eight of sixteen cases, intraoperative monitoring was used, and in four of the patients hearing was preserved. In eight cases, intraoperative monitoring was not used, and hearing was preserved in only two patients. The overall success rate—in total tumor removal with hearing preservation—was 37%. Hearing was preserved in six of eight patients who had tumors which measured less than 1.5 cm. In this group of cases, two of the patients had a Class I good hearing result (PTA 0 to 30 dB and 70 to 100% discrimination), one patient had Class III nonserviceable hearing, (PTA 65 to 75 dB and 25 to 45% discrimination), and three patients had Class IV poor hearing, (PTA 80 to 100 dB and 0 to 20% discrimination). We found that continuous monitoring of direct eighth-nerve-evoked action potentials were extremely valuable and rapidly indicated reversible cochlear nerve trauma.

Pitfalls in intraoperative nerve monitoring during vestibular schwannoma surgery

2012 ◽  
Vol 33 (3) ◽  
pp. E5 ◽  
Author(s):  
Matthew L. Kircher ◽  
Jack M. Kartush
Keyword(s):  
Vestibular Schwannoma ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Nerve Monitoring ◽  
Surgeon Training ◽  
Monitoring Process ◽  
Recurrent Laryngeal Nerves ◽  
American Society ◽  
Intraoperative Nerve Monitoring ◽  
American Society Of Anesthesiologists

Despite the widespread acceptance of intraoperative neurophysiological monitoring in skull base surgery over the last 2 decades, surgeon training in the technical and interpretive aspects of nerve monitoring has been conspicuously lacking. Inadequate fundamental knowledge of neurophysiological monitoring may lead to misinterpretations and an inability to troubleshoot system errors. Some surgeons perform both the technical and interpretive aspects of monitoring themselves while others enjoin coworkers (surgical residents, nurses, anesthetists, or a separate monitoring service) to perform the technical portion. Regardless, the surgeon must have a thorough understanding to avoid potential medical and legal pitfalls because poor monitoring is worse than no monitoring. A structured curriculum and protocol in both the technical and interpretive aspects of monitoring is recommended for all personnel involved in the monitoring process. This paper details the technical, interpretive, and surgical correlates necessary for optimal intraoperative nerve monitoring during vestibular schwannoma surgery with an emphasis on electromyographic monitoring for facial and recurrent laryngeal nerves. Just as the American Society of Anesthesiologists' 1986 “Standards for Basic Anesthetic Monitoring” became a useful tool for both patients and anesthesiologists, impending guidelines in intraoperative neurophysiological monitoring should likewise become an important instrument for optimizing intraoperative neurophysiological monitoring.

scholarly journals Staging in giant vestibular schwannoma surgery: A two consecutive day technique for complete resection in basic neurosurgical setups

2014 ◽  
Vol 05 (03) ◽  
pp. 225-230
Author(s):  
Deepak Bandlish ◽  
Nilay Biswas ◽  
Sumit Deb
Keyword(s):  
Vestibular Schwannoma ◽  
Complete Resection ◽  
Vestibular Schwannomas ◽  
Karnofsky Performance Score ◽  
Duration Of Symptoms ◽  
Lower Cranial Nerve ◽  
Nerve Monitoring ◽  
Ultrasonic Aspirator ◽  
Maximal Diameter ◽  
Ventriculoperitoneal Shunting

ABSTRACT Introduction: Vestibular schwannomas constitute 8% of all intracranial tumors. A majority of vestibular schwannomas are sporadic and unilateral. Giant vestibular schwannomas are seen in our country due to the late diagnosis and long duration of symptoms before diagnosis. These giant schwannomas are challenging to manage as most of the patients are having brainstem compression. Materials and Methods: Twelve cases of a giant vestibular schwannoma were operated in our department between May 2011 and December 2012. Vestibular schwannomas with a maximal diameter of more than 4 cm were defined as a giant vestibular schwannoma. All the patients had a unilateral vestibular schwannoma. Performance status of all the patients were graded as per the Karnofsky performance score. Pre-operative assessment of 5th, 7th, 8th and lower cranial nerve status was done in all cases. Ventriculoperitoneal shunting was done pre-operatively in all cases. All patients were operated through retromastoid suboccipital craniectomy and retrosigmoid approach. These patients were operated in two stages in two consecutive days with overnight elective ventilation in ICU. Ultrasonic aspirator and nerve monitoring techniques were not used. Results: Giant acoustic schwannomas can be safely resected completely by a staged resection on two consecutive days without any increased morbidity or mortality. This technique may be employed to achieve complete resection of such lesions without deterioration of facial nerve function in institutions which do not have advanced facilities like nerve monitoring or ultrasonic aspirator.

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