Neurophysiologic monitoring in posterior fossa surgery. I. Technical principles, applicability and limitations

In 135 cases of posterior fossa surgery almost exclusively in the cerebellopontine angle (CPA) intraoperative monitoring of brain-stem acoustic evoked potentials (BAEP) and partly somatosensory evoked potentials (SEP) was performed. The series consisted of 20 microvascular decompressions, 63 acoustic neurinomas, 7 vascular lesions and 45 other space occupying lesions, mostly in the CPA. BAEP monitoring alone was employed in 76 cases, combined BAEP and SEP monitoring less frequently. The technique of anaesthesia and intraoperative monitoring is presented in detail including an analysis of technical problems (17 in 135 = 13% of cases) and technical failures (11 of 135 = 8%). The results of monitoring brainstem pathways contralateral to the lesion are detailed. It is concluded that the technical principles of evoked potential monitoring in posterior fossa surgery are well established. The applications and limits of this technique including its modifications are described.