Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
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Facial Motor Evoked Potential Techniques and Functional Prediction during Cerebello-pontine Angle Surgery

소뇌교각 수술 중에 안면운동유발전위의 검사방법과 기능적 예측인자

  • Baek, Jae-Seung (Department of Neurology, Samsung Medical Center) ;
  • Park, Sang-Ku (Department of Neurology, Samsung Medical Center) ;
  • Kim, Dong-Jun (Department of Neurology, Samsung Medical Center) ;
  • Park, Chan-Woo (Department of Neurology, Samsung Medical Center) ;
  • Lim, Sung-Hyuk (Department of Neurology, Samsung Medical Center) ;
  • Lee, Jang Ho (Department of Clinical Laboratory Science, Semyung University) ;
  • Cho, Young-Kuk (Department of Medical Laboratory Science, Seoyeong University)
  • Received : 2018.09.13
  • Accepted : 2018.10.22
  • Published : 2018.12.31
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Abstract

Facial motor evoked potential (FMEP) by multi-pulse transcranial electrical stimulation (mpTES) can complement free-running electromyography (EMG) and direct facial nerve stimulation to predict the functional integrity of the facial nerve during cerebello-pontine angle (CPA) tumor surgery. The purpose of this paper is to examine the standardized test methods and the usefulness of FMEP as a predictor of facial nerve function and to minimize the incidence of facial paralysis as an aftereffect of surgery. TES was delivered through electrode Mz (cathode) - M3/M4 (anode), and extracranially direct distal facial muscle excitation was excluded by the absence of single pulse response (SPR) and by longer onset latency (more than 10 ms). FMEP from the orbicularis oris (o.oris) and the mentalis muscle simultaneously can improve the accuracy and success rate compared with FMEP from the o.oris alone. Using the methods described, we can effectively predict facial nerve outcomes immediately after surgery with a reduction of more than 50% of FMEP amplitude as a warning criterion. In conclusion, along with free-running EMG and direct facial nerve stimulation, FMEP is a useful method to reduce the incidence of facial paralysis as a sequela during CPA tumor surgery.

다중펄스경두개전기자극(mpTES)을 이용한 안면운동유발전위(FMEP)는 자유 진행 근전도와 직접적인 안면 신경 자극법의 한계점을 보완하고 소뇌교각 종양 수술 중에 안면 신경의 기능적인 완전성을 예측할 수 있다. 본 논문의 목적은 이 검사의 표준화된 검사방법과 안면 신경의 기능예측인자로서의 유용성을 알아보고 수술 후 중대한 후유증인 안면마비 발생률을 최소화하는 것이다. Mz (음극)-M3, M4 (양극) 전극으로 경두개전기자극을 주고 안면운동유발전위의 단일펄스반응(SPR)의 부재와 10 ms이상의 잠복기를 확인해서 직접적인 두개 외 말초 안면 근육 자극을 배제하고 구륜근(orbicularis oris)과 턱근(mentalis)에서 동시에 측정하면 구륜근에서만 측정했을 때보다 안면운동유발전위의 정확도와 성공률을 높일 수 있다. 본 논문에서는 안면운동유발전위의 50% 진폭감소를 경고기준으로 해서 수술 직후 안면 신경의 결과를 효과적으로 예측할 수 있었다. 결론적으로, 소뇌교각 종양 수술 중에 FMEP는 자유 진행 근전도와 직접적인 안면 신경 자극법과 더불어서 수술 후 중대한 후유증인 안면 마비 발생률을 최소화 할 수 있는 유용한 검사방법이다.

Keywords

References

  1. Sala F, Manganotti P, Tramontano V, Bricolo A, Gerosa M. Monitoring of motor pathways during brain stem surgery: what we have achieved and what we still miss? Neurophysiol Clin. 2007;37:399-406. https://doi.org/10.1016/j.neucli.2007.09.013
  2. Goldbrunner RH, Schlake HP, Milewski C, Tonn JC, Helms J, Roosen K. Quantitative parameters of intraoperative electromyography predict facial nerve outcomes for vestibular schwannoma surgery. Neurosurgery. 2000;46:1140-1146. https://doi.org/10.1097/00006123-200005000-00023
  3. Harper CM, Daube JR. Facial nerve electromyography and other cranial nerve monitoring. J Clin Neurophysiol. 1998;15:206-216. https://doi.org/10.1097/00004691-199805000-00004
  4. Moller AR, Jannetta PJ. Preservation of facial function during removal of acoustic neuromas: use of monopolar constant-voltage stimulation and EMG. J Neurosurg. 1984;61:757-760. https://doi.org/10.3171/jns.1984.61.4.0757
  5. Romstock J, Strauss C, Fahlbusch R. Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery. J Neurosurg. 2000;93:586-593. https://doi.org/10.3171/jns.2000.93.4.0586
  6. Hone SW, Commins DJ, Rames P, Chen JM, Rowed D, McLean A, et al. Prognostic factors in intraoperative facial nerve monitoring for acoustic neuroma. J Otolaryngol. 1997; 26:374-378.
  7. Nakao Y, Piccirillo E, Falcioni M, Taibah A, Kobayashi T, Sanna M. Electromyographic evaluation of facial nerve damage in acoustic neuroma surgery. Otol Neurotol. 2001;22:554-557. https://doi.org/10.1097/00129492-200107000-00024
  8. Silverman H, Willcox TO, Rosenberg SI, Seidman MD. Prediction of facial nerve function following acoustic neuroma resection using intraoperative facial nerve stimulation. Laryngoscope. 1994;104:539-544. https://doi.org/10.1002/lary.5541040506
  9. Sobottka SB, Schackert G, May SA, Wiegleb M, Reiss G. Intraoperative facial nerve monitoring (IFNM) predicts facial nerve outcome after resection of vestibular schwannoma. Acta Neurochir. 1998;140:235-243. https://doi.org/10.1007/s007010050090
  10. Yingling CD, Gardi JN. Intraoperative monitoring of facial and cochlear nerves during acoustic neuroma surgery. 1992. Neurosurg Clin N Am. 2008;19:289-315. https://doi.org/10.1016/j.nec.2008.02.011
  11. Akagami R, Dong CC, Westerberg BD. Localized transcranial electrical motor evoked potentials for monitoring cranial nerves in cranial base surgery. Neurosurgery. 2005;57:78-85.
  12. Fukuda M, Oishi M, Takao T, Saito A, Fujii Y. Facial nerve motor evoked potential monitoring during skull base surgery predicts facial nerve outcome. J Neurol Neurosurg Psychiatry. 2008;79:1066-1070. https://doi.org/10.1136/jnnp.2007.130500
  13. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve-preservation and restitution of function. Neurosurgery. 1997;40:684-694. https://doi.org/10.1097/00006123-199704000-00006
  14. Calancie B, Harris W, Broton JG, Alexeeva N, Green BA. "Threshold-level" multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring. J Neurosurg. 1998;88:457-470. https://doi.org/10.3171/jns.1998.88.3.0457
  15. Dong CC, MacDonald DB, Janusz MT. Intraoperative spinal cord monitoring during descending thoracic and thoracoabdominal aneurysm surgery. Ann Thorac Surg. 2002;74:1873-1876. https://doi.org/10.1016/S0003-4975(02)04137-1
  16. Jacobs MJ, Meylaerts SA, de Haan P, de Mol BA, Kalkman CJ. Strategies to prevent neurologic deficit based on motor-evoked potentials in type I and II thoracoabdominal aortic aneurysm repair. J Vasc Surg. 1999;29:48-57. https://doi.org/10.1016/S0741-5214(99)70349-6
  17. Ulkatan S, Deletis V, Fernandez-Conejero I. Central or peripheral activations of the facial nerve? J Neurosurg. 2007;106:519-520. https://doi.org/10.3171/jns.2007.106.3.519
  18. Dong CC, MacDonald DB, Akagami R, Westerberg B, Alkhani A, Kanaan I, et al. Intraoperative facial motor evoked potential monitoring with transcranial electrical stimulation during skull base surgery. Clin Neurophysiol. 2005;116:588-596. https://doi.org/10.1016/j.clinph.2004.09.013
  19. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93:146-147. https://doi.org/10.1177/019459988509300202
  20. Park SK. Intraoperative neurophysiological monitoring in cerebello pontine angle tumor. Korean J Clin Lab Sci. 2014;46:38-45. https://doi.org/10.15324/kjcls.2014.46.1.38

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