Evoked potential changes produced by positioning for retromastoid craniectomy

Reversible changes in brain stem auditory evoked potentials (BAEPs) occurred in a patient with hemifacial spasm when she was positioned for retromastoid craniectomy. The peak latencies increased and the amplitudes decreased. These alterations persisted for 3 hours, but returned immediately toward normal when the head was removed from pin fixation and the neck was returned to a neutral position. Similar BAEP changes were documented during a second procedure. Audiograms were normal pre- and postoperatively, although minimal BAEP changes were seen after operation. Our observation sheds light on possible mechanisms of intraoperative BAEP alteration and provides new information about the degree and duration of intraoperative BAEP distortion that can be tolerated in at least some cases without permanent neurological sequelae.