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J Neurol Surg A Cent Eur Neurosurg 2021; 82(04): 369-374
DOI: 10.1055/s-0040-1709162
Surgical Technique

Cerebellopontine Angle Surgery Assisted by Continuous Mapping of the Facial Nerve Via the Ultrasonic Aspirator

Marco Cenzato
1   Department of Neurosurgery, Great Niguarda Hospital, Milano, Lombardia, Italy
,
Roberto Stefini
2   Department of Neurosurgery, Ospedale Civile di Legnano, Legnano, Lombardia, Italy
,
Francesco Zenga
3   Department of Neurosurgery, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
,
Maurizio Piparo
1   Department of Neurosurgery, Great Niguarda Hospital, Milano, Lombardia, Italy
,
Alberto Debernardi
1   Department of Neurosurgery, Great Niguarda Hospital, Milano, Lombardia, Italy
,
Ilaria Costi
4   Department of Neurophysiology, Great Niguarda Hospital, Milano, Lombardia, Italy
,
Enrica Fava 
5   Department of Neurosurgery, Great Niguarda Hospital, Università degli Studi di Milano BIOMETRA,, Milano, Lombardia, Italy
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Abstract

Background Cerebellopontine angle (CPA) surgery carries the risk of lesioning the facial nerve. The goal of preserving the integrity of the facial nerve is usually pursued with intermittent electrical stimulation using a handheld probe that is alternated with the resection. We report our experience with continuous electrical stimulation delivered via the ultrasonic aspirator (UA) used for the resection of a series of vestibular schwannomas.

Methods A total of 17 patients with vestibular schwannomas, operated on between 2010 and 2018, were included in this study. A constant-current stimulator was coupled to the UA used for the resection, delivering square-wave pulses throughout the resection. The muscle responses from upper and lower face muscles triggered by the electrical stimulation were displayed continuously on multichannel neurophysiologic equipment. The careful titration of the electrical stimulation delivered through the UA while tapering the current intensity with the progression of the resection was used as the main strategy.

Results All operations were performed successfully, and facial nerve conduction was maintained in all patients except one, in whom a permanent lesion of the facial nerve followed a miscommunication to the neurosurgeon.

Conclusion The coupling of the electrical stimulation to the UA provided the neurosurgeon with an efficient and cost-effective tool and allowed a safe resection. Positive responses were obtained from the facial muscles with low current intensity (lowest intensity: 0.1 mA). The availability of a resection tool paired with a stimulator allowed the surgeon to improve the surgical workflow because fewer interruptions were necessary to stimulate the facial nerve via a handheld probe.

Keywords

ultrasonic aspirator - electrical stimulation - facial nerve - vestibular schwannoma


Publication History

Received: 21 March 2019

Accepted: 22 October 2019

Article published online:
21 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References/

  • 1 Seidel K, Biner MS, Zubak I, Rychen J, Beck J, Raabe A. Continuous dynamic mapping to avoid accidental injury of the facial nerve during surgery for large vestibular schwannomas. Neurosurg Rev 2018; October 26 (Epub ahead of print)
    PubMed
  • 2 Cornelius JF, Schipper J, Tortora A. et al. Continuous and dynamic facial nerve mapping during surgery of cerebellopontine angle tumors: clinical pilot series. World Neurosurg 2018; 119: e855-e863
    CrossrefPubMedSearch in Google Scholar
  • 3 Jallo GI. CUSA EXcel ultrasonic aspiration system. Neurosurgery 2001; 48 (03) 695-697
    CrossrefPubMedSearch in Google Scholar
  • 4 Shiban E, Krieg SM, Obermueller T, Wostrack M, Meyer B, Ringel F. Continuous subcortical motor evoked potential stimulation using the tip of an ultrasonic aspirator for the resection of motor eloquent lesions. J Neurosurg 2015; 123 (02) 301-306
    CrossrefPubMedSearch in Google Scholar
  • 5 Barzilai O, Lidar Z, Constantini S, Salame K, Bitan-Talmor Y, Korn A. Continuous mapping of the corticospinal tracts in intramedullary spinal cord tumor surgery using an electrified ultrasonic aspirator. J Neurosurg Spine 2017; 27 (02) 161-168
    CrossrefPubMedSearch in Google Scholar
  • 6 Roth J, Korn A, Bitan-Talmor Y, Kaufman R, Ekstein M, Constantini S. Subcortical mapping using an electrified Cavitron Ultrasonic Aspirator in pediatric supratentorial surgery. World Neurosurg 2017; 101: 357-364
    CrossrefPubMedSearch in Google Scholar
  • 7 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
    CrossrefPubMedSearch in Google Scholar
  • 8 Koos WT, Spetzler RF, Lang J. Color Atlas of Microneurosurgery: Intracranial Tumors. 2nd ed. Stuttgart, Germany: Thieme; 1993
    Search in Google Scholar
  • 9 Delgado TE, Bucheit WA, Rosenholtz HR, Chrissian S. Intraoperative monitoring of facial muscle evoked responses obtained by intracranial stimulation of the facial nerve: a more accurate technique for facial nerve dissection. Neurosurgery 1979; 4 (05) 418-421
    CrossrefPubMedSearch in Google Scholar
  • 10 Boëx C, Momjian S, Schaller K. Letter to the editor: Electric current application for motor tract mapping. J Neurosurg 2016; 124 (06) 1881-1883
    CrossrefPubMedSearch in Google Scholar
  • 11 Dong CC, Macdonald DB, Akagami R. et al. Intraoperative facial motor evoked potential monitoring with transcranial electrical stimulation during skull base surgery. Clin Neurophysiol 2005; 116 (03) 588-596
    CrossrefPubMedSearch in Google Scholar
  • 12 Li Z, Wang M, Zhang L. et al. Neuronavigation-guided corticospinal tract mapping in brainstem tumor surgery: better preservation of motor function. World Neurosurg 2018; 116: e291-e297
    CrossrefPubMedSearch in Google Scholar