Utility of preoperative electrophysiological testing of the facial nerve in patients with vestibular schwannoma

Autoři: Przemysław Kunert aff001;  Anna Podgórska aff001;  Tomasz Andrzej Dziedzic aff001;  Andrzej Marchel aff001
Působiště autorů: Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland aff001
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226607



The aim of this study was to analyze the utility of various preoperative electrophysiological tests of the facial nerve CNVII in predicting CNVII function after vestibular schwannoma surgery.


This retrospective study included 176 patients who had preoperative facial nerve electroneurography and electrically evoked blink reflex testing. We defined the following variables: axonal degeneration of CNVII (AD-CNVII), trigeminal nerve damage (D-CNV), disturbances in the short-latency pathway of the blink reflex (D-BR), and any changes in electrophysiological test results (A-EMG).


AD-CNVII, D-CNV, D-BR, and A-EMG were noted in 24%, 10%, 64%, and 71% of the patients, respectively. Negative D-CNV correlated with good CNVII function in early (p = 0.005) and long-term follow-up (p = 0.003) but was not an independent prognostic factor for postoperative facial muscles function. D-CNV appeared to be closely related to tumor size. D-BR was related to tumor size and had no predictive value. AD-CNVII (amplitude reduction of 50% or more compared to the healthy side) was an independent factor associated with increased risk of facial muscles weakness (p = 0.015 and p = 0.031 for early and late outcomes, respectively).


Further studies are needed to establish which tests and cut-off values are the most useful for predicting post-surgical facial nerve function.

Klíčová slova:

Electrophysiology – Face – Facial nerve – Muscle electrophysiology – Neurophysiology – Reflexes – Surgical and invasive medical procedures – Surgical oncology


1. Delgado TE, Bucheit WA, Rosenholtz HR, Chrissian S. Intraoperative monitoring of facila muscle evoked responses obtained by intracranial stimulation of the facila nerve: a more accurate technique for facila nerve dissection. Neurosurgery. 1979;4(5):418–21. Epub 1979/05/01. doi: 10.1227/00006123-197905000-00007 460569.

2. Marin P, Pouliot D, Fradet G. Facial nerve outcome with a peroperative stimulation threshold under 0.05 mA. Laryngoscope. 2011;121(11):2295–8. Epub 2011/10/25. doi: 10.1002/lary.22359 22020881.

3. Zeitouni AG, Hammerschlag PE, Cohen NL. Prognostic significance of intraoperative facial nerve stimulus thresholds. Am J Otol. 1997;18(4):494–7. Epub 1997/07/01. 9233491.

4. Darrouzet V, Hilton M, Pinder D, Wang JL, Guerin J, Bebear JP. Prognostic value of the blink reflex in acoustic neuroma surgery. Otolaryngol Head Neck Surg. 2002;127(3):153–7. Epub 2002/09/26. doi: 10.1067/mhn.2002.127606 12297803.

5. van Dinther JJ, Van Rompaey V, Somers T, Zarowski A, Offeciers FE. Prognostic significance of electrophysiological tests for facial nerve outcome in vestibular schwannoma surgery. B-ENT. 2011;7(2):115–9. Epub 2011/08/16. 21838096.

6. Bloch O, Sughrue ME, Kaur R, Kane AJ, Rutkowski MJ, Kaur G, et al. Factors associated with preservation of facial nerve function after surgical resection of vestibular schwannoma. J Neurooncol. 2011;102(2):281–6. Epub 2010/08/10. doi: 10.1007/s11060-010-0315-5 20694574.

7. Sughrue ME, Kaur R, Kane AJ, Rutkowski MJ, Kaur G, Yang I, et al. The value of intraoperative facial nerve electromyography in predicting facial nerve function after vestibular schwannoma surgery. J Clin Neurosci. 2010;17(7):849–52. Epub 2010/05/18. doi: 10.1016/j.jocn.2010.02.003 20471836.

8. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146–7. Epub 1985/04/01. doi: 10.1177/019459988509300202 3921901.

9. Delisa JA, L H, Baran EM, Lai K, Spielholz N. Reflex, Wave, and Long Latency. In Manual of Nerve Conduction Velocity and Clinical Neurophysiology. New York: Raven Press. 1994:160–5.

10. The blink reflex J. K. Electrodiagnostic in diseases of Nerve and Muscle: Principle and Practice Oxford: Oxford University Press. 2001:419–20.

11. Prell J, Rachinger J, Scheller C, Alfieri A, Strauss C, Rampp S. A real-time monitoring system for the facial nerve. Neurosurgery. 2010;66(6):1064–73; discussion 73. Epub 2010/04/14. doi: 10.1227/01.NEU.0000369605.79765.3E 20386137.

12. Wedekind C, Vahl J, Ernestus RI, Klug N. Prognostic significance of preoperative electrophysiologic investigation for facial nerve outcome in acoustic neuroma surgery. Muscle Nerve. 2000;23(12):1868–71. Epub 2000/12/05. doi: 10.1002/1097-4598(200012)23:12<1868::aid-mus11>3.0.co;2-h 11102911.

13. Thomsen J, Zander Olsen P, Tos M. Pre- and postoperative facial nerve testing in patients with acoustic neuromas. Acta Otolaryngol. 1985;99(3–4):239–44. Epub 1985/03/01. doi: 10.3109/00016488509108904 4013717.

14. Normand MM, Daube JR. Cranial nerve conduction and needle electromyography in patients with acoustic neuromas: a model of compression neuropathy. Muscle Nerve. 1994;17(12):1401–6. Epub 1994/12/01. doi: 10.1002/mus.880171209 7969241.

15. Pavesi G, Macaluso GM, Tinchelli S, Medici D, Ventura P, Mancia D. Presurgical electrophysiological findings in acoustic nerve tumours. Electromyogr Clin Neurophysiol. 1992;32(3):119–23. Epub 1992/03/01. 1555526.

16. Nagahiro S, Matsukado Y, Kaku M, Wada S, Urasaki E. [Evaluation of blink reflexes in cerebellopontine angle tumors]. No To Shinkei. 1983;35(11):1117–24. Epub 1983/11/01. 6607058.

17. Hopf HC. Topodiagnostic value of brain stem reflexes. Muscle Nerve. 1994;17(5):475–84. Epub 1994/05/01. doi: 10.1002/mus.880170502 8159176.

18. Hohmann D, DeMeester C, Duckert LG. [Electrophysiologic evaluation of the facial nerve in patients with acoustic neuromas. Preliminary results of a comparative study between conventional electroneurography and transcranial magnetic pulse stimulation]. HNO. 1991;39(11):424–8. Epub 1991/11/01. 1663100.

19. Kartush JM, Niparko JK, Graham MD, Kemink JL. Electroneurography: preoperative facial nerve assessment for tumors of the temporal bone. Otolaryngol Head Neck Surg. 1987;97(3):257–61. Epub 1987/09/01. doi: 10.1177/019459988709700302 3118305.

20. Prasad S, Hirsch BE, Kamerer DB, Durrant J, Sekhar LN. Facial nerve function following cerebellopontine angle surgery: prognostic value of electroneurography. Am J Otol. 1993;14(4):326–9. Epub 1993/07/01. 8238265.

21. Matthies C, Samii M. Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation. Neurosurgery. 1997;40(1):1–9; discussion -10. Epub 1997/01/01. doi: 10.1097/00006123-199701000-00001 8971818.

22. Friedman RA, Berliner KI, Bassim M, Ursick J, Slattery WH 3rd, Schwartz MS, et al. A paradigm shift in salvage surgery for radiated vestibular schwannoma. Otol Neurotol. 2011;32(8):1322–8. Epub 2011/09/08. doi: 10.1097/MAO.0b013e31822e5b76 21897324.

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2019 Číslo 12
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