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Intraoperative facial nerve electromyography parameters to optimize postoperative facial nerve outcome in patients with large unilateral vestibular schwannoma

  • Original Article - Tumor - Schwannoma
  • Published:
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Abstract

Background

Decision-making for large sporadic vestibular schwannomas (VS) resection guided by the intraoperative change in supramaximal facial nerve (FN) amplitude and latency response to optimize post-operative FN outcome.

Methods

Prospectively study of 43 patients, from January to December 2018, of large sporadic VS with preoperative normal FN function at our center. Tumors were removed through retrosigmoid (81%) or translabyrinthine (19%) approaches with FN monitoring. Intraoperative pre- and post-VS resection supramaximal (2 mA) amplitude and latency responses at the proximal FN root were recorded.

Results

Total, near-/subtotal VS resections (TR, NTR, STR) were achieved in 51%, 38%, and 11% of tumors, respectively, guided by no more than 40% decrease in supramaximal amplitude. Pre- and post-resection supramaximal amplitude and latency responses were lower and longer, respectively, in NTR+STR than in TR. At day 8, FN function was grade I–II in 77% of patients and grade III–V in 23%, and after 6 months, it was in grade I-II in 95% and grade III in 5%, and there was no significant difference between TR and NTR+STR. Facial palsy occurred in older patients and in the case of severe FN adhesion. At day 8, pre- and post-resection supramaximal amplitude but not latency responses were different between FN grade III-V and grade I-II. Serviceable hearing was preserved in 28% of large VS.

Conclusions

Intraoperative FN monitoring guided VS resection in large VS so that 49% retained some residual tumor. Accordingly, 95% good postoperative FN function and significant hearing preservation were achieved after 6 months.

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Acknowledgements

We gratefully thank Amgad Hamza (S&S for Biostatistical Analysis, Alexandria, Egypt) for assistance with statistical analysis.

Funding

Mohamed Elsayed was provided financial support in the form of Ministry of Higher Education, Mission sector, Egypt (http://www.mohe-casm.edu.eg) and the Ministry of Scientific Research.

Huan Jia was provided financial support in the form of Shanghai Scientific and Technological Innovation Action Plan (17441903600), and Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases. (14DZ2260300). The sponsor had no role in the design or conduct of this research.

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Author notes

  1. Mohamed Elsayed and Huan Jia contributed equally to this work.

Authors and Affiliations

  1. Department of Otology, Auditory Implants and Skull Base Surgery, Sorbonne Université-APHP6, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France

    Mohamed Elsayed, Huan Jia, Baptiste Hochet, Olivier Sterkers, Renato Torres, Yann Nguyen, Isabelle Bernat, Ghizlene Lahlou & Michel Kalamarides

  2. Department of Clinical Neurophysiology, Sorbonne Université-APHP6, Groupe Hospitalier Pitié-Salpêtrière, Paris, France

    Mohamed Elsayed, Huan Jia, Baptiste Hochet, Olivier Sterkers, Yann Nguyen, Isabelle Bernat & Ghizlene Lahlou

  3. Faculty of Medicine, ORL Department, Alexandria University, Alexandria, Egypt

    Mohamed Elsayed

  4. Department of Otolaryngology Head & Neck Surgery, Shanghai 9th People’s Hospital, Shanghai Jiat Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China

    Huan Jia

  5. Facultad de Medicina, Centro de Investigación y Desarrollo Científico, Universidad Nacional de San Agustín, Arequipa, Peru

    Renato Torres

  6. Department of Neurosurgery, Sorbonne Université-APHP6, Groupe Hospitalier Pitié-Salpêtrière, Paris, France

    Michel Kalamarides

  7. Service de Neurochirurgie, Hôpital Pitié-Salpêtrière, 47-83 boulevard de l’Hôpital, 75013, Paris, France

    Michel Kalamarides

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  1. Mohamed Elsayed
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  7. Isabelle Bernat
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  8. Ghizlene Lahlou
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  9. Michel Kalamarides
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Corresponding authors

Correspondence to Huan Jia or Michel Kalamarides.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional review board approval was obtained from the Ethics Committee of Comite De Protection Des Personnes–Ile de France VI, Groupe Hospitalier Pitié-Salpêtrière (CNIL Authorization No.: 2211758).

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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Elsayed, M., Jia, H., Hochet, B. et al. Intraoperative facial nerve electromyography parameters to optimize postoperative facial nerve outcome in patients with large unilateral vestibular schwannoma. Acta Neurochir 163, 2209–2217 (2021). https://doi.org/10.1007/s00701-021-04814-2

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  • DOI: https://doi.org/10.1007/s00701-021-04814-2

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