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Hearing prognosis and intraoperative guidance of brainstem auditory evoked potential in microvascular decompression
M Sindou1, J L Fobé, D Ciriano
1Department of Neurosurgery A, Hôpital Neurologique, University of Lyon, France.
Abstract:
Intraoperative monitoring of brainstem auditory evoked potential (BAEP) was done in 34 patients submitted to microvascular decompression (MVD). Seventeen of these patients had trigeminal neuralgia, and 17 had hemifacial spasm. Transitory postoperative hearing loss was observed in 6 (18%) of the patients, and permanent hearing loss was observed in 2 (6%) of the patients. Wave I-V interpeak latency (IPL) was calculated during each step of the MVD procedure in order to identify the dangerous steps of the surgery. Wave I-V IPL abnormalities occurred more frequently during cerebellar retraction. Of the 6 patients who had total loss of BAEP lasting throughout the surgery, 1 (17%) had definitive deafness. Ten of the 34 patients had an absence or partial diminution of BAEP without total normalization before the end of surgery. Among these 10 patients, 2 had transitory hearing loss and 1 had permanent hearing loss.
Insights
Brainstem auditory evoked potential (BAEP) monitoring during microvascular decompression (MVD) surgery identified cerebellar retraction as a high-risk step for hearing loss. Monitoring helps detect potential hearing damage during MVD procedures.
Area of Science:
- Neurosurgery
- Neurophysiology
Background:
- Microvascular decompression (MVD) is a surgical procedure to treat neurological conditions like trigeminal neuralgia and hemifacial spasm.
- Intraoperative monitoring is crucial for assessing neural function during complex surgeries.
Purpose of the Study:
- To evaluate the utility of intraoperative brainstem auditory evoked potential (BAEP) monitoring during MVD surgery.
- To identify surgical steps associated with BAEP abnormalities and subsequent hearing loss.
Main Methods:
- Brainstem auditory evoked potential (BAEP) monitoring was performed on 34 patients undergoing MVD for trigeminal neuralgia or hemifacial spasm.
- Wave I-V interpeak latency (IPL) was analyzed throughout the MVD procedure.
- Correlation between BAEP changes and postoperative hearing outcomes was assessed.
Main Results:
- 18% of patients experienced temporary postoperative hearing loss, and 6% had permanent hearing loss.
- Abnormalities in Wave I-V IPL were most frequent during cerebellar retraction.
- Complete loss of BAEP during surgery was associated with a higher risk of permanent deafness.
Conclusions:
- Intraoperative BAEP monitoring is valuable for assessing auditory pathway integrity during MVD.
- Cerebellar retraction is a critical surgical maneuver requiring careful attention to prevent auditory nerve injury.
- Monitoring BAEP can help predict and potentially mitigate postoperative hearing deficits.