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Predictive value of intraoperative neurophysiologic monitoring in assessing long-term facial function in grade IV vestibular schwannoma removal

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Background

Despite routine use of intraoperative neuromonitoring in acoustic neuroma removal, its application in predicting long-term facial function is limited.

Methods

Prospective recording of facial nerve function and subsequent review of intraoperative neurophysiologic data. Stimulation of the facial nerve was performed proximal and distal to the tumor locus after tumor removal with measurement of amplitude and latency responses in the orbicularis oculi and oris muscles. Prospective review of current facial nerve function was performed using the House–Brackmann (HB) scoring system. Good facial function was determined as HB I/II and HB III–VI was considered poor facial function. Minimum follow-up time was 15 months, and averaged 40 months.

Results

Twenty-four grade IV acoustic neuromas (54 % larger than 4 cm) were completely removed from October 2008 to November 2013. Nine patients (37.5 %) had HB I/II and 15 (62.5 %) had HB III–VI. The poor prognosis group had a higher latency than the good prognosis group (p = 0.045). Lower proximal amplitude was detected in the poor prognosis group (p = 0.046). Lower proximal-to-distal amplitude ratio was also detected in the poor prognosis group (p = 0.052). Amplitude ratio cut-offs of 0.44 and 0.25 were able to predict poor prognosis with sensitivity of 0.73 and 0.4 and specificity of 0.78 and 1, respectively (p = 0.046).

Conclusions

Lower proximal amplitude and proximal-distal amplitude ratio were previously reported as predictors of poor facial function in different sizes of vestibular schwannomas. We observed that the same applies specifically for large-sized, completely removed, grade IV tumors. Additionally, we describe a difference in proximal latency time between the good and poor prognosis groups, which was not previously reported.

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Acknowledgments

The authors thank Hélio Alves for the support provided in the statistical analysis.

Conflict of interest

None.

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Authors and Affiliations

  1. Faculty of Medicine, University of Porto, Rua Sto António, n°88 São Mateus, Vila Nova Famalicão, 4765-773, Porto, Portugal

    Sérgio Duarte-Costa & Rui Vaz

  2. Department of Neurosurgery, Centro Hospitalar São João, Porto, Portugal

    Rui Vaz & António Cerejo

  3. Neurophysiology Unit of the Department of Neurology, Centro Hospitalar São João, Porto, Portugal

    Débora Pinto & Fernando Silveira

  4. Neurosciences Center, Hospital Cuf Porto, Porto, Portugal

    Rui Vaz & António Cerejo

Authors
  1. Sérgio Duarte-Costa
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  2. Rui Vaz
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  4. Fernando Silveira
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  5. António Cerejo
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Correspondence to Sérgio Duarte-Costa.

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Comment

The authors have examined the predictive value of intraoperative monitoring in 24 large acoustic neuromas (grade IV). They graded postoperative facial nerve function with the House–Brackmann scoring system. Analysis was done via ANOVA comparing HB score to several neurophysiological values measured intraoperatively—37.5 % of their group had a good outcome (HB 1/2) and 62 % had poor facial function. The main result is the description of amplitude and latency of facial nerve stimulation responses measured proximal and distal of the tumor. They defined certain characteristics typical for the poor prognosis group such as lower proximal amplitude, lower proximal-to-distal amplitude ratio, and amplitude ratio cut-offs. These results have previously been described for smaller schwannomas and the authors claim for the first time that they now have found a difference in proximal latency time between the good and poor prognosis group, previously not reported. It seems to me that one of the purposes of the study is to find out the predictive value of these intraoperative observations for postoperative facial nerve function, which is described by the authors to be poor.

Johannes Schramm

Bonn, Germany

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Duarte-Costa, S., Vaz, R., Pinto, D. et al. Predictive value of intraoperative neurophysiologic monitoring in assessing long-term facial function in grade IV vestibular schwannoma removal. Acta Neurochir 157, 1991–1998 (2015). https://doi.org/10.1007/s00701-015-2571-9

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  • DOI: https://doi.org/10.1007/s00701-015-2571-9

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