소뇌-교각종양 수술시 수술 중 전기생리학적 신경감시에 따른 수술 후 기능적 결과

Intraoperative Neurophysiologic Monitoring and Functional Outcome in Cerebellopontine Angle Tumor Surgery

Objectives : Intraoperative neurophysiologic monitoring(INM) is a well known useful method to reduce intraoperative neurological complications during neurosurgical procedures. Furthermore, INM is required in most cerebellopontine angle(CPA) surgery because cranial nerves or brain stem injuries can result in serious complications. Object of this study is to the correlation between the changes of intraoperative monitoring modalities during cerebellopontine angle tumor surgery and post-operative functional outcomes in auditory and facial functions. Material and Methods : Fifty-seven patients who underwent intraoperative neurophysiologic monitoring during CPA tumor surgery were retrospectively reviewed. Their lesions were as follows ; vestibular schwannomas in 42, other cranial nerve schwannomas in seven, meningiomas in five and cysts in three cases. Pre- and postoperative audiologic examinations and facial nerve function tests were performed in all patients. Intraoperative neurophysiologic monitoring modalities includes brainstem auditory evoked potentials(BAEP) and facial electromyographies(EMG). We compared the events of INM during CPA tumor surgeries with the outcomes of auditory and facial nerve functions. Results : The subjects who had abnormal changes during CPA tumor surgery were twenty cases with BAEP changes and facial EMG changes in twenty one cases. The changes of intraoperative neurophysiologic monitoring did not always result in poor functional outcomes. However, most predictable intraoperative monitoring changes were wave III-V complex losses in BAEP and continuous neurotonic activities in facial EMG. Conclusion : These results indicate that intraoperative neurophysiologic monitoring in CPA tumor surgery usually provide predictive value for postoperative functional outcomes.