Facial Nerve Monitoring in Middle Ear and Mastoid Surgery
Identifieur interne : 002158 ( Istex/Corpus ); précédent : 002157; suivant : 002159Facial Nerve Monitoring in Middle Ear and Mastoid Surgery
Auteurs : Roger S. Noss ; Anil K. Lalwani ; Charles D. YinglingSource :
- The Laryngoscope [ 0023-852X ] ; 2001-05.
English descriptors
- KwdEn :
Abstract
Hypothesis Intraoperative electromyographic facial nerve monitoring, long accepted as the standard of care in surgery for acoustic neuroma and other cerebellopontine angle tumors, may be of aid in middle ear and mastoid surgery. Study Design Retrospective series of 262 cases of middle ear/mastoid surgery in which monitoring was performed by a neurophysiologist. Methods Neurophysiological monitoring events were classified as mechanical or electrical. The voltages producing facial nerve stimulation were compiled and compared with observed facial nerve dehiscence. Results The most common use of monitoring was localization of the facial nerve by electrical stimulation (60%) or identification of mechanically evoked activity (39%). In 57 cases (36%), the first electrical stimulation event evoked a facial nerve response at less than 1 V threshold, indicating little or no bony covering. The minimum stimulation threshold throughout each of these cases was less than 1 V in 88 of the 159 cases (55%) in which stimulation was attempted. In contrast, the facial nerve was visibly dehiscent in only 35 cases (13%). Neurophysiological monitoring confirmed aberrant facial nerve course through the temporal bone in four cases resulting in cancellation of surgical treatment in two cases. Postoperative facial nerve function was preserved in all cases when present preoperatively. Conclusions An electrical stimulation threshold of less than 1 V is a more useful criterion of dehiscence than observation under the operating microscope. The absence of monitoring events allows safe dissection. Monitoring can help locate the facial nerve, guide the dissection and drilling, and confirm its integrity, thereby allowing more definitive surgical treatment while preserving neural function.
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DOI: 10.1097/00005537-200105000-00014
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Facial Nerve Monitoring in Middle Ear and Mastoid Surgery</title><author><name sortKey="Noss, Roger S" sort="Noss, Roger S" uniqKey="Noss R" first="Roger S." last="Noss">Roger S. Noss</name><affiliation><mods:affiliation>Department of Neurological Surgery, University of California, San Francisco, California, U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Lalwani, Anil K" sort="Lalwani, Anil K" uniqKey="Lalwani A" first="Anil K." last="Lalwani">Anil K. Lalwani</name><affiliation><mods:affiliation>Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California, U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Yingling, Charles D" sort="Yingling, Charles D" uniqKey="Yingling C" first="Charles D." last="Yingling">Charles D. Yingling</name><affiliation><mods:affiliation>Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California, U.S.A.</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:8F6191CF9ED7B80A88D6A6D377797044B1BBD579</idno><date when="2001" year="2001">2001</date><idno type="doi">10.1097/00005537-200105000-00014</idno><idno type="url">https://api.istex.fr/document/8F6191CF9ED7B80A88D6A6D377797044B1BBD579/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002158</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Facial Nerve Monitoring in Middle Ear and Mastoid Surgery</title><author><name sortKey="Noss, Roger S" sort="Noss, Roger S" uniqKey="Noss R" first="Roger S." last="Noss">Roger S. Noss</name><affiliation><mods:affiliation>Department of Neurological Surgery, University of California, San Francisco, California, U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Lalwani, Anil K" sort="Lalwani, Anil K" uniqKey="Lalwani A" first="Anil K." last="Lalwani">Anil K. Lalwani</name><affiliation><mods:affiliation>Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California, U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Yingling, Charles D" sort="Yingling, Charles D" uniqKey="Yingling C" first="Charles D." last="Yingling">Charles D. Yingling</name><affiliation><mods:affiliation>Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California, U.S.A.</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">The Laryngoscope</title><title level="j" type="abbrev">The Laryngoscope</title><idno type="ISSN">0023-852X</idno><idno type="eISSN">1531-4995</idno><imprint><publisher>John Wiley & Sons, Inc.</publisher><pubPlace>Hoboken, NJ</pubPlace><date type="published" when="2001-05">2001-05</date><biblScope unit="volume">111</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="831">831</biblScope><biblScope unit="page" to="836">836</biblScope></imprint><idno type="ISSN">0023-852X</idno></series><idno type="istex">8F6191CF9ED7B80A88D6A6D377797044B1BBD579</idno><idno type="DOI">10.1097/00005537-200105000-00014</idno><idno type="ArticleID">LARY5541110514</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0023-852X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Facial nerve dehiscence</term><term>cranial nerve</term><term>electromyography</term><term>intraoperative monitoring</term><term>middle ear surgery</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Hypothesis Intraoperative electromyographic facial nerve monitoring, long accepted as the standard of care in surgery for acoustic neuroma and other cerebellopontine angle tumors, may be of aid in middle ear and mastoid surgery. Study Design Retrospective series of 262 cases of middle ear/mastoid surgery in which monitoring was performed by a neurophysiologist. Methods Neurophysiological monitoring events were classified as mechanical or electrical. The voltages producing facial nerve stimulation were compiled and compared with observed facial nerve dehiscence. Results The most common use of monitoring was localization of the facial nerve by electrical stimulation (60%) or identification of mechanically evoked activity (39%). In 57 cases (36%), the first electrical stimulation event evoked a facial nerve response at less than 1 V threshold, indicating little or no bony covering. The minimum stimulation threshold throughout each of these cases was less than 1 V in 88 of the 159 cases (55%) in which stimulation was attempted. In contrast, the facial nerve was visibly dehiscent in only 35 cases (13%). Neurophysiological monitoring confirmed aberrant facial nerve course through the temporal bone in four cases resulting in cancellation of surgical treatment in two cases. Postoperative facial nerve function was preserved in all cases when present preoperatively. Conclusions An electrical stimulation threshold of less than 1 V is a more useful criterion of dehiscence than observation under the operating microscope. The absence of monitoring events allows safe dissection. Monitoring can help locate the facial nerve, guide the dissection and drilling, and confirm its integrity, thereby allowing more definitive surgical treatment while preserving neural function.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Roger S. Noss PhD</name><affiliations><json:string>Department of Neurological Surgery, University of California, San Francisco, California, U.S.A.</json:string></affiliations></json:item><json:item><name>Anil K. Lalwani MD</name><affiliations><json:string>Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California, U.S.A.</json:string></affiliations></json:item><json:item><name>Charles D. Yingling PhD</name><affiliations><json:string>Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California, U.S.A.</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Facial nerve dehiscence</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>intraoperative monitoring</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>electromyography</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>middle ear surgery</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cranial nerve</value></json:item></subject><articleId><json:string>LARY5541110514</json:string></articleId><language><json:string>eng</json:string></language><abstract>Hypothesis Intraoperative electromyographic facial nerve monitoring, long accepted as the standard of care in surgery for acoustic neuroma and other cerebellopontine angle tumors, may be of aid in middle ear and mastoid surgery. Study Design Retrospective series of 262 cases of middle ear/mastoid surgery in which monitoring was performed by a neurophysiologist. Methods Neurophysiological monitoring events were classified as mechanical or electrical. The voltages producing facial nerve stimulation were compiled and compared with observed facial nerve dehiscence. Results The most common use of monitoring was localization of the facial nerve by electrical stimulation (60%) or identification of mechanically evoked activity (39%). In 57 cases (36%), the first electrical stimulation event evoked a facial nerve response at less than 1 V threshold, indicating little or no bony covering. The minimum stimulation threshold throughout each of these cases was less than 1 V in 88 of the 159 cases (55%) in which stimulation was attempted. In contrast, the facial nerve was visibly dehiscent in only 35 cases (13%). Neurophysiological monitoring confirmed aberrant facial nerve course through the temporal bone in four cases resulting in cancellation of surgical treatment in two cases. Postoperative facial nerve function was preserved in all cases when present preoperatively. Conclusions An electrical stimulation threshold of less than 1 V is a more useful criterion of dehiscence than observation under the operating microscope. The absence of monitoring events allows safe dissection. Monitoring can help locate the facial nerve, guide the dissection and drilling, and confirm its integrity, thereby allowing more definitive surgical treatment while preserving neural function.</abstract><qualityIndicators><score>6.942</score><pdfVersion>1.3</pdfVersion><pdfPageSize>603 x 783 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1783</abstractCharCount><pdfWordCount>3942</pdfWordCount><pdfCharCount>25216</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>258</abstractWordCount></qualityIndicators><title>Facial Nerve Monitoring in Middle Ear and Mastoid Surgery</title><genre.original><json:string>article</json:string></genre.original><genre><json:string>article</json:string></genre><host><volume>111</volume><publisherId><json:string>LARY</json:string></publisherId><pages><total>6</total><last>836</last><first>831</first></pages><issn><json:string>0023-852X</json:string></issn><issue>5</issue><subject><json:item><value>Article</value></json:item></subject><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1531-4995</json:string></eissn><title>The Laryngoscope</title><doi><json:string>10.1002/(ISSN)1531-4995</json:string></doi></host><publicationDate>2001</publicationDate><copyrightDate>2001</copyrightDate><doi><json:string>10.1097/00005537-200105000-00014</json:string></doi><id>8F6191CF9ED7B80A88D6A6D377797044B1BBD579</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/8F6191CF9ED7B80A88D6A6D377797044B1BBD579/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/8F6191CF9ED7B80A88D6A6D377797044B1BBD579/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/8F6191CF9ED7B80A88D6A6D377797044B1BBD579/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Facial Nerve Monitoring in Middle Ear and Mastoid Surgery</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>John Wiley & Sons, Inc.</publisher><pubPlace>Hoboken, NJ</pubPlace><availability><p>WILEY</p></availability><date>2001</date></publicationStmt><notesStmt><note type="content">*Presented in part at the Annual Meeting of the American Society of Neurophysiological Monitoring, San Diego, California, May 5, 2000.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Facial Nerve Monitoring in Middle Ear and Mastoid Surgery</title><author><persName><forename type="first">Roger S.</forename><surname>Noss</surname></persName><roleName type="degree">PhD</roleName><note type="correspondence"><p>Correspondence: Roger S. Noss, PhD, Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143‐0112 U.S.A.</p></note><affiliation>Department of Neurological Surgery, University of California, San Francisco, California, U.S.A.</affiliation></author><author><persName><forename type="first">Anil K.</forename><surname>Lalwani</surname></persName><roleName type="degree">MD</roleName><affiliation>Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California, U.S.A.</affiliation></author><author><persName><forename type="first">Charles D.</forename><surname>Yingling</surname></persName><roleName type="degree">PhD</roleName><affiliation>Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California, U.S.A.</affiliation></author></analytic><monogr><title level="j">The Laryngoscope</title><title level="j" type="abbrev">The Laryngoscope</title><idno type="pISSN">0023-852X</idno><idno type="eISSN">1531-4995</idno><idno type="DOI">10.1002/(ISSN)1531-4995</idno><imprint><publisher>John Wiley & Sons, Inc.</publisher><pubPlace>Hoboken, NJ</pubPlace><date type="published" when="2001-05"></date><biblScope unit="volume">111</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="831">831</biblScope><biblScope unit="page" to="836">836</biblScope></imprint></monogr><idno type="istex">8F6191CF9ED7B80A88D6A6D377797044B1BBD579</idno><idno type="DOI">10.1097/00005537-200105000-00014</idno><idno type="ArticleID">LARY5541110514</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2001</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Hypothesis Intraoperative electromyographic facial nerve monitoring, long accepted as the standard of care in surgery for acoustic neuroma and other cerebellopontine angle tumors, may be of aid in middle ear and mastoid surgery. Study Design Retrospective series of 262 cases of middle ear/mastoid surgery in which monitoring was performed by a neurophysiologist. Methods Neurophysiological monitoring events were classified as mechanical or electrical. The voltages producing facial nerve stimulation were compiled and compared with observed facial nerve dehiscence. Results The most common use of monitoring was localization of the facial nerve by electrical stimulation (60%) or identification of mechanically evoked activity (39%). In 57 cases (36%), the first electrical stimulation event evoked a facial nerve response at less than 1 V threshold, indicating little or no bony covering. The minimum stimulation threshold throughout each of these cases was less than 1 V in 88 of the 159 cases (55%) in which stimulation was attempted. In contrast, the facial nerve was visibly dehiscent in only 35 cases (13%). Neurophysiological monitoring confirmed aberrant facial nerve course through the temporal bone in four cases resulting in cancellation of surgical treatment in two cases. Postoperative facial nerve function was preserved in all cases when present preoperatively. Conclusions An electrical stimulation threshold of less than 1 V is a more useful criterion of dehiscence than observation under the operating microscope. The absence of monitoring events allows safe dissection. Monitoring can help locate the facial nerve, guide the dissection and drilling, and confirm its integrity, thereby allowing more definitive surgical treatment while preserving neural function.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>keywords</head><item><term>Facial nerve dehiscence</term></item><item><term>intraoperative monitoring</term></item><item><term>electromyography</term></item><item><term>middle ear surgery</term></item><item><term>cranial nerve</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>article-category</head><item><term>Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2001-02-13">Registration</change><change when="2001-05">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/8F6191CF9ED7B80A88D6A6D377797044B1BBD579/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>John Wiley & Sons, Inc.</publisherName><publisherLoc>Hoboken, NJ</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-4995</doi><issn type="print">0023-852X</issn><issn type="electronic">1531-4995</issn><idGroup><id type="product" value="LARY"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="LARYNGOSCOPE">The Laryngoscope</title><title type="short">The Laryngoscope</title></titleGroup></publicationMeta><publicationMeta level="part" position="50"><doi origin="wiley" registered="no">10.1002/lary.v111:5</doi><numberingGroup><numbering type="journalVolume" number="111">111</numbering><numbering type="journalIssue">5</numbering></numberingGroup><coverDate startDate="2001-05">May 2001</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="14" status="forIssue"><doi origin="wiley" registered="yes">10.1097/00005537-200105000-00014</doi><idGroup><id type="unit" value="LARY5541110514"></id></idGroup><countGroup><count type="pageTotal" number="6"></count></countGroup><titleGroup><title type="articleCategory">Article</title><title type="tocHeading1">Articles</title></titleGroup><copyright ownership="thirdParty">Copyright © 2001 The Triological Society</copyright><eventGroup><event type="manuscriptAccepted" date="2001-02-13"></event><event type="firstOnline" date="2009-01-02"></event><event type="publishedOnlineFinalForm" date="2009-01-02"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:2.3.1 mode:FullText source:FullText result:FullText" date="2010-02-23"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-01"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-11-04"></event></eventGroup><numberingGroup><numbering type="pageFirst">831</numbering><numbering type="pageLast">836</numbering></numberingGroup><correspondenceTo>Roger S. Noss, PhD, Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143‐0112 U.S.A.</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:LARY.LARY5541110514.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="2"></count><count type="tableTotal" number="4"></count><count type="referenceTotal" number="21"></count></countGroup><titleGroup><title type="main" xml:lang="en">Facial Nerve Monitoring in Middle Ear and Mastoid Surgery<link href="#fn1"></link></title><title type="short" xml:lang="en">Facial Nerve Monitoring in Middle Ear and Mastoid Surgery</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1" corresponding="yes"><personName><givenNames>Roger S.</givenNames><familyName>Noss</familyName><degrees>PhD</degrees></personName><contactDetails><email>rnoss@itsa.ucsf.edu</email></contactDetails></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Anil K.</givenNames><familyName>Lalwani</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Charles D.</givenNames><familyName>Yingling</familyName><degrees>PhD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="US" type="organization"><unparsedAffiliation>Department of Neurological Surgery, University of California, San Francisco, California, U.S.A.</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="US" type="organization"><unparsedAffiliation>Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California, U.S.A.</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">Facial nerve dehiscence</keyword><keyword xml:id="kwd2">intraoperative monitoring</keyword><keyword xml:id="kwd3">electromyography</keyword><keyword xml:id="kwd4">middle ear surgery</keyword><keyword xml:id="kwd5">cranial nerve</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p><b>Hypothesis</b> Intraoperative electromyographic facial nerve monitoring, long accepted as the standard of care in surgery for acoustic neuroma and other cerebellopontine angle tumors, may be of aid in middle ear and mastoid surgery.</p><p><b>Study Design</b> Retrospective series of 262 cases of middle ear/mastoid surgery in which monitoring was performed by a neurophysiologist.</p><p><b>Methods</b> Neurophysiological monitoring events were classified as mechanical or electrical. The voltages producing facial nerve stimulation were compiled and compared with observed facial nerve dehiscence.</p><p><b>Results</b> The most common use of monitoring was localization of the facial nerve by electrical stimulation (60%) or identification of mechanically evoked activity (39%). In 57 cases (36%), the first electrical stimulation event evoked a facial nerve response at less than 1 V threshold, indicating little or no bony covering. The minimum stimulation threshold throughout each of these cases was less than 1 V in 88 of the 159 cases (55%) in which stimulation was attempted. In contrast, the facial nerve was visibly dehiscent in only 35 cases (13%). Neurophysiological monitoring confirmed aberrant facial nerve course through the temporal bone in four cases resulting in cancellation of surgical treatment in two cases. Postoperative facial nerve function was preserved in all cases when present preoperatively.</p><p><b>Conclusions</b> An electrical stimulation threshold of less than 1 V is a more useful criterion of dehiscence than observation under the operating microscope. The absence of monitoring events allows safe dissection. Monitoring can help locate the facial nerve, guide the dissection and drilling, and confirm its integrity, thereby allowing more definitive surgical treatment while preserving neural function.</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p>Presented in part at the Annual Meeting of the American Society of Neurophysiological Monitoring, San Diego, California, May 5, 2000.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Facial Nerve Monitoring in Middle Ear and Mastoid Surgery</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Facial Nerve Monitoring in Middle Ear and Mastoid Surgery</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Facial Nerve Monitoring in Middle Ear and Mastoid Surgery</title></titleInfo><name type="personal"><namePart type="given">Roger S.</namePart><namePart type="family">Noss</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Department of Neurological Surgery, University of California, San Francisco, California, U.S.A.</affiliation><description>Correspondence: Roger S. Noss, PhD, Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143‐0112 U.S.A.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anil K.</namePart><namePart type="family">Lalwani</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California, U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Charles D.</namePart><namePart type="family">Yingling</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California, U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>John Wiley & Sons, Inc.</publisher><place><placeTerm type="text">Hoboken, NJ</placeTerm></place><dateIssued encoding="w3cdtf">2001-05</dateIssued><dateValid encoding="w3cdtf">2001-02-13</dateValid><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">2</extent><extent unit="tables">4</extent><extent unit="references">21</extent></physicalDescription><abstract lang="en">Hypothesis Intraoperative electromyographic facial nerve monitoring, long accepted as the standard of care in surgery for acoustic neuroma and other cerebellopontine angle tumors, may be of aid in middle ear and mastoid surgery. Study Design Retrospective series of 262 cases of middle ear/mastoid surgery in which monitoring was performed by a neurophysiologist. Methods Neurophysiological monitoring events were classified as mechanical or electrical. The voltages producing facial nerve stimulation were compiled and compared with observed facial nerve dehiscence. Results The most common use of monitoring was localization of the facial nerve by electrical stimulation (60%) or identification of mechanically evoked activity (39%). In 57 cases (36%), the first electrical stimulation event evoked a facial nerve response at less than 1 V threshold, indicating little or no bony covering. The minimum stimulation threshold throughout each of these cases was less than 1 V in 88 of the 159 cases (55%) in which stimulation was attempted. In contrast, the facial nerve was visibly dehiscent in only 35 cases (13%). Neurophysiological monitoring confirmed aberrant facial nerve course through the temporal bone in four cases resulting in cancellation of surgical treatment in two cases. Postoperative facial nerve function was preserved in all cases when present preoperatively. Conclusions An electrical stimulation threshold of less than 1 V is a more useful criterion of dehiscence than observation under the operating microscope. The absence of monitoring events allows safe dissection. Monitoring can help locate the facial nerve, guide the dissection and drilling, and confirm its integrity, thereby allowing more definitive surgical treatment while preserving neural function.</abstract><note type="content">*Presented in part at the Annual Meeting of the American Society of Neurophysiological Monitoring, San Diego, California, May 5, 2000.</note><subject lang="en"><genre>keywords</genre><topic>Facial nerve dehiscence</topic><topic>intraoperative monitoring</topic><topic>electromyography</topic><topic>middle ear surgery</topic><topic>cranial nerve</topic></subject><relatedItem type="host"><titleInfo><title>The Laryngoscope</title></titleInfo><titleInfo type="abbreviated"><title>The Laryngoscope</title></titleInfo><genre type="journal">journal</genre><subject><genre>article-category</genre><topic>Article</topic></subject><identifier type="ISSN">0023-852X</identifier><identifier type="eISSN">1531-4995</identifier><identifier type="DOI">10.1002/(ISSN)1531-4995</identifier><identifier type="PublisherID">LARY</identifier><part><date>2001</date><detail type="volume"><caption>vol.</caption><number>111</number></detail><detail type="issue"><caption>no.</caption><number>5</number></detail><extent unit="pages"><start>831</start><end>836</end><total>6</total></extent></part></relatedItem><identifier type="istex">8F6191CF9ED7B80A88D6A6D377797044B1BBD579</identifier><identifier type="DOI">10.1097/00005537-200105000-00014</identifier><identifier type="ArticleID">LARY5541110514</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2001 The Triological Society</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>John Wiley & Sons, Inc.</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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