New methodology for facial nerve monitoring in extracranial surgeries of vascular malformations |
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| Institution: | 1. Department of Intraoperative Neurophysiology, St Luke’s Roosevelt Hospital, Mount Sinai Health System, New York, NY, USA;2. Vascular Birthmark Institute of New York, St Luke’s Roosevelt Hospital, Mount Sinai Health System, New York, NY, USA;3. Department of Interventional Neuroradiology at the Institute for Neurology and Neurosurgery, St Luke’s Roosevelt Hospital, Mount Sinai Health System, New York, NY, USA;1. School of Stomatology, China Medical University, Shenyang, People''s Republic of China;2. Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, Tianjin, People''s Republic of China;3. Department of Head and Neck Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People''s Republic of China;1. Department of Surgery and Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC;2. Department of Surgery, LSU Health New Orleans School of Medicine, New Orleans, LA;3. Department of Surgery, Tulane University Health Sciences Center, New Orleans, LA;4. Department of General Surgery, Lahey Clinic, Tufts Medical School, Burlington, MA;1. Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;2. Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;1. Department of Neurosurgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, Jiangsu 215300, China;2. Department of Neurosurgery, Northern Jiangsu People''s Hospital, Yangzhou, Jiangsu 225001, China;3. Department of Neurosurgery, Zhenjiang Hospital of Traditional Chinese Medicine, Zhenjiang, Jiangsu 212001, China;4. Department of Neurosurgery, Wound Institute of Jiangsu University, Zhenjiang, Jiangsu 212001, China;5. Department of Neurosurgery, Zhenjiang First People''s Hospital, Zhenjiang, Jiangsu 212001, China;6. Department of Neurosurgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China;1. Otolaryngology Department, University Hospital of Verona, Borgo Trento Piazza Aristide Stefani Aristide Stefani 1, Verona 37100, Italy;2. Sinus and Oto Centro–Hospital Geral de Fortaleza, Rua Dr. José Furtado, 1480, Fortaleza 60822-300, Brazil;3. Otolaryngology Department, University Hospital of Alexandria, 36 Rouschdy Street #6, Rouschdy, Alexandria, Egypt;4. Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, Modena 41100, Italy |
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| Abstract: | ObjectiveTo develop a more reliable methodology for monitoring the facial nerve in surgeries of vascular malformations where the extracranial segment of the nerve is at risk.MethodsOur methodology comprises: (1) preoperative mapping to identify the anatomical location of the nerve branches, (2) continuous intraoperative monitoring of the compound muscle action potential (CMAP) by stimulating the facial nerve extracranially, in close proximity to where the trunk of the facial nerve exits the skull at the stylomastoid foramen, (3) intraoperative mapping to identify the nerve branches during surgical dissection and quantify the innervating contribution of each branch to the target muscle.ResultsOnly three out of 201 surgeries (1.5%) had complete facial nerve trunk injury as a consequence of facial vascular malformation surgery.ConclusionsWe developed a new method to continuously stimulate the facial nerve extracranially eliciting an objective parameter—the CMAP amplitude—to constantly measure changes in the muscle responses throughout surgery, alerting the surgeon before the facial nerve is severely injured. Our methodology notably reduces the complete facial nerve injury during extracranial surgery of facial vascular malformations.SignificanceThis comprehensive methodology may also be a valuable tool to prevent facial nerve injury during other types of extracranial surgeries where radical excisions are required. |
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| Keywords: | Facial nerve Surgery Intraoperative monitoring Mapping Vascular malformation |
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