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PubMed1994

Changes in directly recorded cochlear nerve compound action potentials during acoustic tumor surgery.

Damage to labyrinthine, neural, and vascular structures may possibly account for failure to achieve hearing preservation after removal of small acoustic neuromas. The pathogenesis of auditory impairment is, however, sometimes unclear. Intraoperative monitoring of auditory evoked potentials enables us to study possible correlations between surgical maneuvers and the function of auditory structures and pathways. To this end, simultaneous recording of brainstern auditory evoked potentials and direct cochlear nerve action potentials (CNAPs) was utilized in 14 patients with small (12 to 18 mm) unilateral acoustic neuromas. The latency of the first negative component (N(1)) of the CNAPs proved extremely sensitive in detecting intraoperative auditory damage and was a good predictive index of postoperative auditory outcome. Evaluation of temporal and morphologic CNAP patterns allowed identification of coagulation close to the cochlear nerve, drilling of the internal auditory canal, and removal of the intrameatal portion of the tumor, the most critical steps in hearing preservation. The mechanisms of damage are analyzed and discussed.

Journal Article↗
PubMedDate not supplied

AUDITORY ADAPTATION.

Explore the source record for details and available documents.

Audiometry↗
PubMed1990

[Recordings of evoked electromyographic responses from the extraocular muscles to monitor the oculomotor, trochlear, and abducens nerve function during skull base and orbital surgery].

The methods to record evoked electromyographic responses by micro malleable clip electrodes applied directly to the extraocular muscles are described. This electrophysiological monitoring enables surgeons to localize the ocular motor nerves accurately in the skull base of the middle, posterior fossa, and orbit. In cavernous sinus surgery, electrical stimulation over the dura elicited vigorous responses from the extraocular muscles and subsequently it was possible for the surgeon to avoid severing the ocular motor nerves. In orbital surgery, distended and thinned extraocular muscles were precisely localized and preserved anatomically and functionally. These monitoring methods may play the same role as electrical stimulation to the facial nerves in acoustic neuroma surgery.

Abducens Nerve↗
PubMedDate not supplied

Clinical characteristics and treatment outcome for nonvestibular schwannomas of the head and neck.

PURPOSE: Studies involving head and neck schwannomas have focused predominantly on involvement of the vestibulocochlear nerve complex (acoustic neuroma) because of the associated morbidity related to lesions involving that region. However, the majority of head and neck schwannomas are not of vestibular nerve origin and may also produce significant morbidity due to involvement of the orbit, skull base, and cranial nerves. The purpose of this study is to examine the presenting signs and symptoms, location, nerve of origin, and outcome after treatment of patients with nonvestibular schwannomas of the head and neck. MATERIALS AND METHODS: The medical and pathological records of all patients with nonvestibular head and neck schwannomas treated at a single institution between 1979 and 1999 were retrospectively reviewed. RESULTS: Eighteen (69%) of 26 patients presented with symptoms secondary to mass effect or nerve deficit. The parapharyngeal space was the most common site of tumor origin occurring in 8 patients (31%). The nerve of origin was identified in 16 patients (62%). Twenty-three patients (88%) had complete surgical excision, and 3 patients (12%) had subtotal resection. Postoperative nerve injury occurred in 16 patients (62%) with resolution in 7 patients (44%). CONCLUSIONS: Nonvestibular head and neck schwannomas occur most commonly in the parapharyngeal space, and presenting signs or symptoms are usually related to mass effect or neural deficit. Complete tumor removal is often achieved, but subtotal or near-total resection may be indicated for patients with extensive skull base, middle ear, or facial nerve involvement. Postoperative morbidity is associated with nerve injury from the surgical approach and/or resection of the involved nerve.

Adolescent↗