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TcMEP threshold change is superior to A-train detection when predicting facial nerve outcome in CPA tumour surgery
Object Surgery of tumours in the cerebellopontine angle (CPA) can lead to loss of facial nerve function. Different methods of intra-operative nerve monitoring (IOM) (including free-running EMG, direct nerve stimulation and transcranial motor evoked potentials (TcMEP)) have been used to predict facia...
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| Published in: | Acta neurochirurgica 2020-05, Vol.162 (5), p.1197-1203 |
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| container_issue | 5 |
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| container_title | Acta neurochirurgica |
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| creator | Hendriks, Tom Kunst, Henricus P. M. Huppelschoten, Maarten Doorduin, Jonne Ter Laan, Mark |
| description | Object
Surgery of tumours in the cerebellopontine angle (CPA) can lead to loss of facial nerve function. Different methods of intra-operative nerve monitoring (IOM) (including free-running EMG, direct nerve stimulation and transcranial motor evoked potentials (TcMEP)) have been used to predict facial nerve outcome during surgery. Recent research has shown TcMEP threshold increase and the occurrence of A-trains on the EMG to have great potential in doing so. This study compares these two methods and correlates them to House-Brackmann (HB) scores post-op in patients with tumours in the cerebellopontine angle.
Method
Forty-three patients (one was operated twice) with large CPA tumours treated surgically in the Radboud University Medical Center between 2015 and 2019 were included in this study. During surgery, TcMEP threshold increases and A-train activity were measured. Because our treatment paradigm aims at facial nerve preservation (accepting residual tumour), TcMEP threshold increase of over 20 mA or occurrence of A-trains were considered as warning signs and used as a guide for terminating surgery. HB scores were measured post-op, at 6 weeks, 6 months and 1 year after surgery. Spearman’s correlation was calculated between the IOM-values and the HB scores for a homogeneous subgroup of 30 patients with vestibular schwannoma (VS) without neurofibromatosis type II (NF-II) and all patients collectively.
Results
TcMEP threshold was successfully measured in 39 (90.7%) procedures. In the homogeneous VS non-NFII group, we found a statistically significant moderate-to-strong correlation between TcMEP threshold increase and House Brackmann score immediately post-op, at 6 weeks, 6 months and 1 year after surgery (Spearman’s rho of 0.79 (
p
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| doi_str_mv | 10.1007/s00701-020-04275-z |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7156349</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2389518616</sourcerecordid><originalsourceid>FETCH-LOGICAL-c523t-1949dc60d1a40dc86b0555f6ee74b48b4b7edc780c2291febc73f502f67dfe483</originalsourceid><addsrcrecordid>eNp9kUtv1TAQhSMEoqXwB1ggS2zYBGzHj2SDdHVVHlIRXZS15TiTG1eJfbGdVu2vZ8ot5bFgY3s035zx0amql4y-ZZTqdxkPymrKaU0F17K-fVQd007wGg_6GN8U24qr9qh6lvMlVlyL5ml11HAmlOTquEoX7svpOSlTgjzFeSBusmEHxGeS1z0kHxMpkWzqkqwPZIACrvgYyPUEgewTDB7rsCOjdd7OJEC6AhLX4uKCKoFszzekrEtcEwqmHaSb59WT0c4ZXtzfJ9W3D6cX20_12dePn7ebs9pJ3pSadaIbnKIDs4IOrlU9lVKOCkCLXrS96DUMTrfUcd6xEXqnm1FSPio9jCDa5qR6f9Ddr_2CKAT0MJt98otNNyZab_7uBD-ZXbwymknViA4F3twLpPh9hVzM4rODebYB4poNb7SUjEp2t-v1P-glOg5oD6m2Q0QxhRQ_UC7FnBOMD59h1NxFag6RGozU_IzU3OLQqz9tPIz8yhCB5gBkbGF26ffu_8j-AFVDrrQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2389518616</pqid></control><display><type>article</type><title>TcMEP threshold change is superior to A-train detection when predicting facial nerve outcome in CPA tumour surgery</title><source>Springer Link</source><creator>Hendriks, Tom ; Kunst, Henricus P. M. ; Huppelschoten, Maarten ; Doorduin, Jonne ; Ter Laan, Mark</creator><creatorcontrib>Hendriks, Tom ; Kunst, Henricus P. M. ; Huppelschoten, Maarten ; Doorduin, Jonne ; Ter Laan, Mark</creatorcontrib><description>Object
Surgery of tumours in the cerebellopontine angle (CPA) can lead to loss of facial nerve function. Different methods of intra-operative nerve monitoring (IOM) (including free-running EMG, direct nerve stimulation and transcranial motor evoked potentials (TcMEP)) have been used to predict facial nerve outcome during surgery. Recent research has shown TcMEP threshold increase and the occurrence of A-trains on the EMG to have great potential in doing so. This study compares these two methods and correlates them to House-Brackmann (HB) scores post-op in patients with tumours in the cerebellopontine angle.
Method
Forty-three patients (one was operated twice) with large CPA tumours treated surgically in the Radboud University Medical Center between 2015 and 2019 were included in this study. During surgery, TcMEP threshold increases and A-train activity were measured. Because our treatment paradigm aims at facial nerve preservation (accepting residual tumour), TcMEP threshold increase of over 20 mA or occurrence of A-trains were considered as warning signs and used as a guide for terminating surgery. HB scores were measured post-op, at 6 weeks, 6 months and 1 year after surgery. Spearman’s correlation was calculated between the IOM-values and the HB scores for a homogeneous subgroup of 30 patients with vestibular schwannoma (VS) without neurofibromatosis type II (NF-II) and all patients collectively.
Results
TcMEP threshold was successfully measured in 39 (90.7%) procedures. In the homogeneous VS non-NFII group, we found a statistically significant moderate-to-strong correlation between TcMEP threshold increase and House Brackmann score immediately post-op, at 6 weeks, 6 months and 1 year after surgery (Spearman’s rho of 0.79 (
p
< 0.001), 0.74 (
p
< 0.001), 0.64 (
p
< 0.001) and 0.58 (
p
= 0.002), respectively). For A-trains, no correlation was found. Similar results were found when including all patients with CPA tumours. A threshold increase of < 20 mA was a predictor of good facial nerve outcome.
Conclusion
These results show that TcMEP threshold increases are strongly correlated to post-operative HB scores, while A-trains are not. This suggests TcMEP threshold increases can be a valuable predictor for facial nerve outcome in patients with large tumours when facial nerve preservation is prioritized over total resection. In this study, we found no use for A-trains to prevent facial nerve deficits.</description><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-020-04275-z</identifier><identifier>PMID: 32146526</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Electromyography ; Facial nerve ; Genetic disorders ; Interventional Radiology ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgery ; Motor evoked potentials ; Neurofibromatosis ; Neurological disorders ; Neurology ; Neuroradiology ; Neurosurgery ; Original - Tumor - Schwannoma ; Original Article - Tumor - Schwannoma ; Patients ; Preservation ; Schwann cells ; Statistical analysis ; Surgery ; Surgical Orthopedics ; Tumor – Schwannoma ; Tumors ; Vestibular system</subject><ispartof>Acta neurochirurgica, 2020-05, Vol.162 (5), p.1197-1203</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c523t-1949dc60d1a40dc86b0555f6ee74b48b4b7edc780c2291febc73f502f67dfe483</citedby><cites>FETCH-LOGICAL-c523t-1949dc60d1a40dc86b0555f6ee74b48b4b7edc780c2291febc73f502f67dfe483</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,786,790,891,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32146526$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hendriks, Tom</creatorcontrib><creatorcontrib>Kunst, Henricus P. M.</creatorcontrib><creatorcontrib>Huppelschoten, Maarten</creatorcontrib><creatorcontrib>Doorduin, Jonne</creatorcontrib><creatorcontrib>Ter Laan, Mark</creatorcontrib><title>TcMEP threshold change is superior to A-train detection when predicting facial nerve outcome in CPA tumour surgery</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>Object
Surgery of tumours in the cerebellopontine angle (CPA) can lead to loss of facial nerve function. Different methods of intra-operative nerve monitoring (IOM) (including free-running EMG, direct nerve stimulation and transcranial motor evoked potentials (TcMEP)) have been used to predict facial nerve outcome during surgery. Recent research has shown TcMEP threshold increase and the occurrence of A-trains on the EMG to have great potential in doing so. This study compares these two methods and correlates them to House-Brackmann (HB) scores post-op in patients with tumours in the cerebellopontine angle.
Method
Forty-three patients (one was operated twice) with large CPA tumours treated surgically in the Radboud University Medical Center between 2015 and 2019 were included in this study. During surgery, TcMEP threshold increases and A-train activity were measured. Because our treatment paradigm aims at facial nerve preservation (accepting residual tumour), TcMEP threshold increase of over 20 mA or occurrence of A-trains were considered as warning signs and used as a guide for terminating surgery. HB scores were measured post-op, at 6 weeks, 6 months and 1 year after surgery. Spearman’s correlation was calculated between the IOM-values and the HB scores for a homogeneous subgroup of 30 patients with vestibular schwannoma (VS) without neurofibromatosis type II (NF-II) and all patients collectively.
Results
TcMEP threshold was successfully measured in 39 (90.7%) procedures. In the homogeneous VS non-NFII group, we found a statistically significant moderate-to-strong correlation between TcMEP threshold increase and House Brackmann score immediately post-op, at 6 weeks, 6 months and 1 year after surgery (Spearman’s rho of 0.79 (
p
< 0.001), 0.74 (
p
< 0.001), 0.64 (
p
< 0.001) and 0.58 (
p
= 0.002), respectively). For A-trains, no correlation was found. Similar results were found when including all patients with CPA tumours. A threshold increase of < 20 mA was a predictor of good facial nerve outcome.
Conclusion
These results show that TcMEP threshold increases are strongly correlated to post-operative HB scores, while A-trains are not. This suggests TcMEP threshold increases can be a valuable predictor for facial nerve outcome in patients with large tumours when facial nerve preservation is prioritized over total resection. In this study, we found no use for A-trains to prevent facial nerve deficits.</description><subject>Electromyography</subject><subject>Facial nerve</subject><subject>Genetic disorders</subject><subject>Interventional Radiology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally Invasive Surgery</subject><subject>Motor evoked potentials</subject><subject>Neurofibromatosis</subject><subject>Neurological disorders</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Original - Tumor - Schwannoma</subject><subject>Original Article - Tumor - Schwannoma</subject><subject>Patients</subject><subject>Preservation</subject><subject>Schwann cells</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Tumor – Schwannoma</subject><subject>Tumors</subject><subject>Vestibular system</subject><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kUtv1TAQhSMEoqXwB1ggS2zYBGzHj2SDdHVVHlIRXZS15TiTG1eJfbGdVu2vZ8ot5bFgY3s035zx0amql4y-ZZTqdxkPymrKaU0F17K-fVQd007wGg_6GN8U24qr9qh6lvMlVlyL5ml11HAmlOTquEoX7svpOSlTgjzFeSBusmEHxGeS1z0kHxMpkWzqkqwPZIACrvgYyPUEgewTDB7rsCOjdd7OJEC6AhLX4uKCKoFszzekrEtcEwqmHaSb59WT0c4ZXtzfJ9W3D6cX20_12dePn7ebs9pJ3pSadaIbnKIDs4IOrlU9lVKOCkCLXrS96DUMTrfUcd6xEXqnm1FSPio9jCDa5qR6f9Ddr_2CKAT0MJt98otNNyZab_7uBD-ZXbwymknViA4F3twLpPh9hVzM4rODebYB4poNb7SUjEp2t-v1P-glOg5oD6m2Q0QxhRQ_UC7FnBOMD59h1NxFag6RGozU_IzU3OLQqz9tPIz8yhCB5gBkbGF26ffu_8j-AFVDrrQ</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Hendriks, Tom</creator><creator>Kunst, Henricus P. M.</creator><creator>Huppelschoten, Maarten</creator><creator>Doorduin, Jonne</creator><creator>Ter Laan, Mark</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200501</creationdate><title>TcMEP threshold change is superior to A-train detection when predicting facial nerve outcome in CPA tumour surgery</title><author>Hendriks, Tom ; Kunst, Henricus P. M. ; Huppelschoten, Maarten ; Doorduin, Jonne ; Ter Laan, Mark</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c523t-1949dc60d1a40dc86b0555f6ee74b48b4b7edc780c2291febc73f502f67dfe483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Electromyography</topic><topic>Facial nerve</topic><topic>Genetic disorders</topic><topic>Interventional Radiology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally Invasive Surgery</topic><topic>Motor evoked potentials</topic><topic>Neurofibromatosis</topic><topic>Neurological disorders</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Original - Tumor - Schwannoma</topic><topic>Original Article - Tumor - Schwannoma</topic><topic>Patients</topic><topic>Preservation</topic><topic>Schwann cells</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Tumor – Schwannoma</topic><topic>Tumors</topic><topic>Vestibular system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hendriks, Tom</creatorcontrib><creatorcontrib>Kunst, Henricus P. M.</creatorcontrib><creatorcontrib>Huppelschoten, Maarten</creatorcontrib><creatorcontrib>Doorduin, Jonne</creatorcontrib><creatorcontrib>Ter Laan, Mark</creatorcontrib><collection>Springer Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hendriks, Tom</au><au>Kunst, Henricus P. M.</au><au>Huppelschoten, Maarten</au><au>Doorduin, Jonne</au><au>Ter Laan, Mark</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>TcMEP threshold change is superior to A-train detection when predicting facial nerve outcome in CPA tumour surgery</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2020-05-01</date><risdate>2020</risdate><volume>162</volume><issue>5</issue><spage>1197</spage><epage>1203</epage><pages>1197-1203</pages><issn>0001-6268</issn><eissn>0942-0940</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Object
Surgery of tumours in the cerebellopontine angle (CPA) can lead to loss of facial nerve function. Different methods of intra-operative nerve monitoring (IOM) (including free-running EMG, direct nerve stimulation and transcranial motor evoked potentials (TcMEP)) have been used to predict facial nerve outcome during surgery. Recent research has shown TcMEP threshold increase and the occurrence of A-trains on the EMG to have great potential in doing so. This study compares these two methods and correlates them to House-Brackmann (HB) scores post-op in patients with tumours in the cerebellopontine angle.
Method
Forty-three patients (one was operated twice) with large CPA tumours treated surgically in the Radboud University Medical Center between 2015 and 2019 were included in this study. During surgery, TcMEP threshold increases and A-train activity were measured. Because our treatment paradigm aims at facial nerve preservation (accepting residual tumour), TcMEP threshold increase of over 20 mA or occurrence of A-trains were considered as warning signs and used as a guide for terminating surgery. HB scores were measured post-op, at 6 weeks, 6 months and 1 year after surgery. Spearman’s correlation was calculated between the IOM-values and the HB scores for a homogeneous subgroup of 30 patients with vestibular schwannoma (VS) without neurofibromatosis type II (NF-II) and all patients collectively.
Results
TcMEP threshold was successfully measured in 39 (90.7%) procedures. In the homogeneous VS non-NFII group, we found a statistically significant moderate-to-strong correlation between TcMEP threshold increase and House Brackmann score immediately post-op, at 6 weeks, 6 months and 1 year after surgery (Spearman’s rho of 0.79 (
p
< 0.001), 0.74 (
p
< 0.001), 0.64 (
p
< 0.001) and 0.58 (
p
= 0.002), respectively). For A-trains, no correlation was found. Similar results were found when including all patients with CPA tumours. A threshold increase of < 20 mA was a predictor of good facial nerve outcome.
Conclusion
These results show that TcMEP threshold increases are strongly correlated to post-operative HB scores, while A-trains are not. This suggests TcMEP threshold increases can be a valuable predictor for facial nerve outcome in patients with large tumours when facial nerve preservation is prioritized over total resection. In this study, we found no use for A-trains to prevent facial nerve deficits.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>32146526</pmid><doi>10.1007/s00701-020-04275-z</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Acta neurochirurgica, 2020-05, Vol.162 (5), p.1197-1203 |
| issn | 0001-6268 0942-0940 |
| language | eng |
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| source | Springer Link |
| subjects | Electromyography Facial nerve Genetic disorders Interventional Radiology Medicine Medicine & Public Health Minimally Invasive Surgery Motor evoked potentials Neurofibromatosis Neurological disorders Neurology Neuroradiology Neurosurgery Original - Tumor - Schwannoma Original Article - Tumor - Schwannoma Patients Preservation Schwann cells Statistical analysis Surgery Surgical Orthopedics Tumor – Schwannoma Tumors Vestibular system |
| title | TcMEP threshold change is superior to A-train detection when predicting facial nerve outcome in CPA tumour surgery |
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