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Park, Sang-Ku,Joo, Byung-Euk,Lee, Seunghoon,Lee, Jeong-A.,Hwang, Jeong-Ho,Kong, Doo-Sik,Seo, Dae-Won,Park, Kwan,Lee, Hoon-Taek Elsevier 2018 CLINICAL NEUROPHYSIOLOGY - Vol.129 No.5
<P><B>Abstract</B></P> <P><B>Objective</B></P> <P>The aim of this study was to define the critical warning sign of real-time brainstem auditory evoked potential (BAEP) for predicting hearing loss (HL) after microvascular decompression (MVD) for hemifacial spasm (HFS).</P> <P><B>Methods</B></P> <P>Nine hundred and thirty-two patients with HFS who underwent MVD with intraoperative monitoring (IOM) of BAEP were analyzed. We used a 43.9 Hz/s stimulation rate and 400 averaging trials to obtain BAEP. To evaluate HL, pure-tone audiometry and speech discrimination scoring were performed before and one week after surgery. We analyzed the incidence for postoperative HL according to BAEP changes and calculated the diagnostic accuracy of significant warning criteria.</P> <P><B>Results</B></P> <P>Only 11 (1.2%) patients experienced postoperative HL. The group showing permanent loss of wave V showed the largest percentage of postoperative HL (<I>p</I> < 0.001). No patient who experienced only latency prolongation (≥1 ms) had postoperative HL. Loss of wave V and latency prolongation (≥1 ms) with amplitude decrement (≥50%) were highly associated with postoperative HL.</P> <P><B>Conclusions</B></P> <P>Loss of wave V and latency prolongation of 1 ms with amplitude decrement ≥50% were the critical warning signs of BAEP for predicting postoperative HL.</P> <P><B>Significance</B></P> <P>These findings elucidate the critical warning sign of real-time BAEP.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Critical warning sign of real-time BAEP during MVD for hemifacial spasm have been studied. </LI> <LI> Loss of wave V and the significant change of both latency and amplitude are the critical signs. </LI> <LI> Isolated wave V latency prolongation of >1 ms without amplitude loss >50% is not saaociated with postoperative hearing loss. </LI> </UL> </P>
Park, Sang-Ku,Joo, Byung-Euk,Park, Kwan The Korean Neurosurgical Society 2019 Journal of Korean neurosurgical society Vol.62 No.4
Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.