European Archives of Oto-Rhino-Laryngology

, Volume 254, Issue 3, pp 140–144 | Cite as

Perioperative lesions of the facial nerve: follow-up investigations using transcranial magnetic stimulation

  • S. Kotterba
  • M. Tegenthoff
  • J. -P. Malin
Original Paper


Peripheral facial palsy can occur after aural surgery and neurosurgery. Routine neurophysiological investigation (utilizing electrical stimulation and the blink reflex) does not allow the direct assessment of the site of a lesion. In the present study transcranial magnetic stimulation (TMS) was applied in order to evaluate the usefulness of this method for prognosis. Twenty-three patients with postoperative facial pareses (after removals of an acoustic neuroma in 12 patients and parotid tumors in 11) were investigated. Ipsilateral short-latency and contralateral long-latency responses (after cortex stimulation) were elicited. At the first examination (11.7 ± 9 days after onset of the palsy) the components of the blink reflex were absent in all cases. Responses to electrical stimulation were abnormal in 80%. Ipsilateral short-latency responses after TMS could be obtained in 7 patients. Pathological long-latency TMS responses were elicited in 17 patients. Follow-up investigations up to 2 years revealed no prognostic aspects from peripheral electrical stimulation, the blink reflex and the short-latency TMS response. The absence or extent of delay in long-latency responses at first examination was strongly correlated with final clinical outcomes. As improvements of the responses preceded clinical regressions of the paresis, TMS proved to be an important neurophysiological method for an early prognosis of recovery after perioperative lesions of the facial nerve.

Key words

Aural surgery Postsurgical complications Facial palsy Transcranial magnetic stimulation 


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  1. 1.
    Barker AT, Jalinous R, Freeston IL (1985) Noninvasive magnetic stimulation of the human motor cortex. Lancet I:1106–1107CrossRefGoogle Scholar
  2. 2.
    Benecke R, Meyer B-U, Schönle P, Conrad B (1988) Transcranial magnetic stimulation of the human brain: responses in muscles supplied by cranial nerves. Exp Brain Res 71:623–632PubMedCrossRefGoogle Scholar
  3. 3.
    Benecke R, Meyer B-U, Schönle P, Conrad B (1988) Beurteilung motorischer Hirnnervenfunktionen mit Hilfe der transkraniellen magnetischen Stimulation. Z EEG-EMG 19:228–233Google Scholar
  4. 4.
    Eisen A, Danon J (1979) The orbicularis oculi reflex in acoustic neurinoma: a clinical and electrodiagnostic evaluation. Neurology 29:45–50Google Scholar
  5. 5.
    Esslen E (1977) The acute facial palsies. Springer, Berlin Heidelberg New YorkGoogle Scholar
  6. 6.
    Glocker FX, Magistris MR, Rösler KM, Hess CW (1994) Magnetic transcranial and electrical stylomastoidal stimulation of the facial motor pathways in Bell's palsy: time course and relevance of electrophysiological parameters. Electroencephalogr Clin Neurophysiol 93:113–120PubMedCrossRefGoogle Scholar
  7. 7.
    Höhmann D, DeMeester C, Duckert LG (1991) Elektrophysiologische Beurteilung des Nervus facialis bei Patienten mit Akustikusneurinomen. HNO 39:424–428PubMedGoogle Scholar
  8. 8.
    House JW, Brackman DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147PubMedGoogle Scholar
  9. 9.
    Jaspert A, Kotterba S, Tegenthoff M, Malin J-P (1992) Transkranielle Magnetstimulation im Hinnervenbereich bei Schädel-Hirn-Verletzten. EEG-EMG 23:37–42PubMedGoogle Scholar
  10. 10.
    Kotterba S, Jaspert A, Tegenthoff M, Malin J-P (1994) Followup investigation of peripheral facial palsy by transcranial magnetic stimulation. Electromyogr Clin Neurophysiol 34:335–339PubMedGoogle Scholar
  11. 11.
    Maccabee PJ, Amassian VE, Cracco RQ, Cracco JB, Anziska BJ (1988) Intracranial stimulation of facial nerve in human with the magnetic coil. Electroencephalogr Clin Neurophysiol 70:350–354PubMedCrossRefGoogle Scholar
  12. 12.
    Meyer B-U, Britton TC, Benecke R (1988) Investigation of unilateral facial weakness: magnetic stimulation of the proximal facial nerve and of the face associated motor cortex. J Neurol 236:102–107CrossRefGoogle Scholar
  13. 13.
    Meyer B-U, Wehrhahn K, Rothwell JC, Roericht S (1994) Functional organisation of corticonuclear pathways to motoneurons of lower facial muscles in man. Exp Brain Res 101:465–472PubMedCrossRefGoogle Scholar
  14. 14.
    Rösler KM, Hess CW, Schmid UD (1989) Investigation of facial motor pathways by electrical and magnetic stimulation: sites and mechanisms of excitation. J Neurol Neurosurg Psychiatry 52:1149–1156PubMedGoogle Scholar
  15. 15.
    Rösler KM, Jenni WK, Schmid UD, Hess CW (1994) Electrophysiological characterization of pre- and postoperative facial nerve function in patients with acoustic neuroma using electrical and magnetic stimulation techniques. Muscle Nerve 17:183–191PubMedCrossRefGoogle Scholar
  16. 16.
    Schmid UD, Moeller AR, Schmid J (1991) Transcranial magnetic stimulation excites the labyrinthine segment of the facial nerve: an intraoperative study in man. Neurosci Lett 124:273–276PubMedCrossRefGoogle Scholar
  17. 17.
    Schriefer TN, Mills KR, Murray NMF, Hess CW (1988) Evaluation of proximal facial nerve conduction by transcranial magnetic stimulation. J Neurol Neurosurg Psychiatry 51:60–66PubMedCrossRefGoogle Scholar
  18. 18.
    Stöhr M, Bluthardt M (1987) Atlas der klinischen Elektromyographie and ueurographie. Kohlhammer, StuttgartGoogle Scholar
  19. 19.
    Tokimura H, Yamagami M, Tokimura Y, Asakura T, Atsuchi M (1993) Transcranial magnetic stimulation excites the root exit zone of the facial nerve. Neurosurgery 32:414–416PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • S. Kotterba
    • 1
  • M. Tegenthoff
    • 1
  • J. -P. Malin
    • 1
  1. 1.Department of NeurologyRuhr University, BG-Kliniken BergmannsheilBochumGermany

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