Intraoperative blink reflex monitoring during skull base surgery: a single-institution method

Cranial nerve (CN) preservation remains a challenge for skull base neurosurgeons, and neurophysiological intraoperative monitoring presents many methods for CN identification and mapping. The blink reflex, which is the electrophysiological representation of the corneal reflex, can be used to test both trigeminal and facial nerve function. The objective of this study was to present a method for obtaining a reliable blink reflex response and maintaining it during the course of a procedure.

A method for robust blink reflex recording is presented. Electrode placement, recording parameters, stimulation parameters, anesthetic considerations, and reliability troubleshooting are described.

This method has been iteratively developed at the authors' institution across multiple sites for more than 5 years. The blink reflex was monitored in multiple cranial approaches and for various pathologies. The most common cases monitored were vestibular schwannoma resections and microvascular decompressions. The most common cranial approaches were the translabyrinthine, retrosigmoid/suboccipital, and middle cranial fossa approaches.

To gain a more comprehensive understanding of the clinical utility of the blink reflex in surgical decision-making and outcome prediction, prospective studies involving larger patient cohorts are warranted. This report outlines a reproducible methodology and invites validation and constructive input from the broader neurosurgical and neuromonitoring communities.