Acta neurochirurgica
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Acta neurochirurgica · May 2020
Comparative StudyTcMEP threshold change is superior to A-train detection when predicting facial nerve outcome in CPA tumour surgery.
Surgery of tumours in the cerebellopontine angle (CPA) can lead to loss of facial nerve function. Different methods of intra-operative nerve monitoring (IOM) (including free-running EMG, direct nerve stimulation and transcranial motor evoked potentials (TcMEP)) have been used to predict facial nerve outcome during surgery. Recent research has shown TcMEP threshold increase and the occurrence of A-trains on the EMG to have great potential in doing so. This study compares these two methods and correlates them to House-Brackmann (HB) scores post-op in patients with tumours in the cerebellopontine angle. ⋯ These results show that TcMEP threshold increases are strongly correlated to post-operative HB scores, while A-trains are not. This suggests TcMEP threshold increases can be a valuable predictor for facial nerve outcome in patients with large tumours when facial nerve preservation is prioritized over total resection. In this study, we found no use for A-trains to prevent facial nerve deficits.
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Acta neurochirurgica · May 2020
Case ReportsTransmastoid presigmoid retrolabyrinthine approach for removal of pontine cavernous malformation: how I do it.
Bleeding of brainstem cavernous malformations (BSCM) cause high morbidity and should be treated surgically whenever possible. ⋯ A transmastoid presigmoid retrolabyrinthine approach through LPZ is safe and effective for lateral pontine BSCM resection.