Intraoperative Neurophysiologic Monitoring and Functional Outcome in Cerebellopontine Angle Tumor Surgery

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

  • Lee, Sang Koo (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Kwan (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Ik Seong (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Seo, Dae Won (Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Uhm, Dong Ok (Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Nam, Do-Hyun (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jung-Il (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jong Soo (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hong, Seung Chyul (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shin, Hyung Jin (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Eoh, Whan (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jong Hyun (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 이상구 (성균관대학교 의과대학 삼성서울병원 신경외과학교실) ;
  • 박관 (성균관대학교 의과대학 삼성서울병원 신경외과학교실) ;
  • 박익성 (성균관대학교 의과대학 삼성서울병원 신경외과학교실) ;
  • 서대원 (성균관대학교 의과대학 삼성서울병원 신경과학교실) ;
  • 엄동옥 (성균관대학교 의과대학 삼성서울병원 신경과학교실) ;
  • 남도현 (성균관대학교 의과대학 삼성서울병원 신경외과학교실) ;
  • 이정일 (성균관대학교 의과대학 삼성서울병원 신경외과학교실) ;
  • 김종수 (성균관대학교 의과대학 삼성서울병원 신경외과학교실) ;
  • 홍승철 (성균관대학교 의과대학 삼성서울병원 신경외과학교실) ;
  • 신형진 (성균관대학교 의과대학 삼성서울병원 신경외과학교실) ;
  • 어환 (성균관대학교 의과대학 삼성서울병원 신경외과학교실) ;
  • 김종현 (성균관대학교 의과대학 삼성서울병원 신경외과학교실)
  • Received : 1999.09.29
  • Accepted : 2000.02.29
  • Published : 2000.06.28

Abstract

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.

Keywords