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The utility of “low current” stimulation threshold of intraoperative electromyography monitoring in predicting facial nerve function outcome after vestibular schwannoma surgery: a prospective cohort study of 103 large tumors

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Abstract

To investigate the predictive utility of stimulation threshold (ST) of intraoperative electromyography monitoring for facial nerve (FN) outcomes among vestibular schwannoma (VS) patients postoperatively. The authors enrolled 103 unilateral VS patients who underwent surgical resection into a prospective cohort observational study from January 2013 to April 2015 in our hospital. ST values were used to categorize 81 patients into the “low current” (ST ≤ 0.05 mA) group and 22 patients into the control (ST > 0.05 mA) group. The FN function outcomes were summarized and correlated with these two groups at 1, 3, 6, and 12 months after surgery. Binary regression analysis revealed that the percentage of “good” FN outcome, defined by House-Brackmann (HB) classification of facial function (I–II), in the “low current” group was significantly higher than that of the control group (42.0 vs. 4.5% at 1 month, P = 0.015; 64.2 vs. 31.8% at 3 months, P = 0.024; 72.8 vs. 40.9% at 6 months, P = 0.021; 84.0 vs. 45.5% at 12 months, P = 0.002). Ordinal regression analysis showed that the distribution of HB scores was shifted in a favorable direction in the “low current” group at 1, 3, 6, and 12 months postoperatively. For patients with HB IV at the first month postoperative period, the recovery rate of the “low current” group was significantly higher than that of control group (P = 0.003). “Low current” can predict FN function outcomes better and has faster recovery rates than that of the control group.

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Abbreviations

CI:

Confidence intervals

EMG:

Electromyography

FN:

Facial nerve

HB:

House-Brackmann classification of facial function

MRI:

Magnetic resonance imaging

OR:

Odds ratios

ST:

Stimulation threshold

VS:

Vestibular schwannoma

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Acknowledgements

We would like to thank all the patients who trusted us and all the staff who helped this study. This study is supported by Shanghai biomedical guidance project, Shanghai Science and Technology Commission, China (Grant No. 134119a4700) and Yang Fan project (Grant No. 15YF1401500). The study is also part of China Spark Program, supported by Ministry of Science and Technology, China (Grant No. S2013C000013).

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  1. Xiang Huang and Junwei Ren have contributed equally to the article.

Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China

    Xiang Huang, Junwei Ren, Jian Xu, Ming Xu, Danqi Chen, Mingyu Chen, Kaiyuan Ji, Hai Wang, Ping Zhong, Liangfu Zhou & Ying Mao

  2. Department of Ophthalmology and Visual Science, Eye, and ENT Hospital, 83 Fenyang Road, Shanghai, 200031, China

    Huiyu Chen

  3. Shanghai Medical College, Fudan University, 138 College Way, Shanghai, 200032, China

    Lijie Cao & Yilin Shao

  4. Department of Neuroscience, Pomona College, 333 College Way, Claremont, 91711, CA, USA

    Richard Ballena

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  1. Xiang Huang
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Correspondence to Ping Zhong.

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This study was approved by Institutional Review Board of Huashan Hospital, Fudan University, Shanghai, China.

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Huang, X., Ren, J., Xu, J. et al. The utility of “low current” stimulation threshold of intraoperative electromyography monitoring in predicting facial nerve function outcome after vestibular schwannoma surgery: a prospective cohort study of 103 large tumors. J Neurooncol 138, 383–390 (2018). https://doi.org/10.1007/s11060-018-2806-8

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