Application value of facial nerve motor evoked potential monitoring in vestibular schwannoma surgery
Objective To investigate the predictive value of intraoperative monitoring of facial nerve motor evoked potentials(FNMEPs)on facial nerve function(FNF)post vestibular schwannoma(VS)surgery.Methods A retrospective analysis was conducted on the clinical data of 60 patients with VS who were admitted to the Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University from May 2020 to December 2020.FNMEP was recorded on the orbicularis oculi,orbicularis oris and mentalis muscles of all patients during the operation,and the FNMEP amplitude decrease rate when the dura mater was sutured was determined.The patients'facial nerve function was evaluated using the House-Brackmann facial nerve function grading system(referred to as H-B classification)1 week and 6 months after surgery,and they were divided into a group with good facial nerve function(H-B classification ≤ grade Ⅱ)and a group with poor facial nerve function(H-B classification＞grade Ⅱ).The clinical data of the two groups of patients were compared,and indicators with P＜0.20 were included in multivariate logistic regression analysis to explore the predictive factors of postoperative facial nerve function outcomes.The receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to determine the critical value and predictive efficacy for predicting facial neurological outcome after VS surgery.Results Among 60 patients,the successful induction rates of FNMEPs from the orbicularis oculi,orbicularis oris and mentalis muscles were 40.0％(24/60),91.7％(55/60)and 98.3％(59/60)respectively.Total tumor resection was achieved in 48 patients(80.0％)during surgery.The proportion of patients with good facial nerve functionat 1 week and 6 months after surgery accounted for 26.7％(16/60)and 68.3％(41/60)respectively.The results of univariate analysis showed that 1 week after surgery,the differences in the amplitude reduction rates of FNMEP in the orbicularis oculi and orbicularis oris muscles between the two groups were statistically significant(both P＜0.05).Six months after surgery,there were statistically significant differences in the maximum diameter of the tumor and the amplitude reduction rate of FNMEP in the orbicularis oculi,orbicularis oris and mentalis muscles between the two groups(all P＜0.05).The results of multivariate logistic regression analysis showed that the amplitude decrease of FNMEP in the orbicularis oris muscle was the predictor factor of facial nerve function outcome at 1 week after surgery(OR=1.03,95％CI:1.01-1.06,P=0.015)and 6 months after surgery(OR=1.05,95％CI:1.02-1.08,P=0.001),and the critical values were 33.2％and 48.7％respectively(AUCs:0.736 and 0.829 respectively,both P＜0.05).Conclusions Intraoperative FNMEP monitoring,particularly its recording results on the orbicularis oris muscle,can effectively reflect the outcome of postoperative facial nerve function in patients with VS.It is recommended that the amplitude decrease rate＞50％be used as an intraoperative early warning standard.
Neuroma,acousticNeurophysiological monitoringTreatment outcomeFacial nerve functionPredictive value
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