Intraoperative Neuromonitoring of Blink Reflex During Posterior Fossa Surgeries and Its Correlation With Clinical Outcome.

Autor:	Aydinlar EI; Department of Neurology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey., Kocak M; Department of Neurology, Acibadem Altunizade Hospital, Istanbul, Turkey., Soykam HO; Department of Biostatistics and Bioinformatics, Life Science Institute, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey., Mat B; Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey; and., Dikmen PY; Department of Neurology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey., Sezerman OU; Department of Biostatistics and Bioinformatics, Life Science Institute, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey., Elmaci İ; Department of Neurosurgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey., Pamir MN; Department of Neurosurgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.
Jazyk:	angličtina
Zdroj:	Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society [J Clin Neurophysiol] 2022 May 01; Vol. 39 (4), pp. 299-306. Date of Electronic Publication: 2020 Sep 28.
DOI:	10.1097/WNP.0000000000000777
Abstrakt:	Purpose: Blink reflex (BR) under general anesthesia as an intraoperative neuromonitoring method was used to monitor facial nerves in few studies. This study aimed to test the utility of intraoperative BR during cerebellopontine angle and skull base surgeries, assess its prognostic value for facial nerve functions, and compare it with facial corticobulbar motor evoked potentials (CoMEPs). Methods: Blink reflex and facial CoMEPs were recorded from 40 patients undergoing skull base surgeries. Subdermal needles were placed in the supraorbital notch for stimulation and in the orbicularis oculi muscle for recording the BR. A double train of 20 to 40 V intensity with an intertrain interval of 40 to 60 milliseconds, an interstimulus interval of 2.5 milliseconds, and a stimulus duration of 0.5 milliseconds were applied. Facial nerve functions were assessed with the House-Brackmann grading system in the postoperative day 1 and third-month period and correlated with intraoperative BR and CoMEPs measurements. Results: Of 40 patients, BR was recordable on the affected side in 32 (80%) and contralateral side in 35 (87.5%) patients. According to our statistical results, BR had a slightly better sensitivity than facial CoMEPs in predicting impairment of facial nerve functions for both postoperative and third-month time points. Blink reflex showed better accuracy for predicting postoperative nerve functions, whereas CoMEPs correlated better in predicting third-month outcome. Conclusions: We suggest that BR is a valuable intraoperative neuromonitoring method that can be used in addition to facial CoMEPs during skull base surgeries to assess real-time facial nerve integrity and predict prognosis. Competing Interests: The authors have no funding or conflicts of interest to disclose. (Copyright © 2020 by the American Clinical Neurophysiology Society.)
Databáze:	MEDLINE
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