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A-trains for intraoperative monitoring in patients with recurrent vestibular schwannoma

  • Clinical Article - Functional
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Abstract

Background

Second surgery of recurrent vestibular schwannoma (VS) after previous surgery, stereotactic radiosurgery (SR) or fractionated radiotherapy (FR) carries an increased risk for deterioration of facial nerve function, e.g., due to adhesions, underlining the need for intraoperative monitoring. Facial “A-train” EMG activity (“traintime”) correlates with the degree of postoperative facial palsy. Studies investigating A-trains in VS patients with previous surgery, SR or FR are missing. We therefore investigated the value of A-train monitoring in patients undergoing second surgery for VS.

Method

Intraoperative EMG data from patients who underwent second surgery for VS after previous surgery, SR and/or FR at our institution between 2006 and 2012 were retrospectively analyzed. Ten patients were selected (5 male): Seven had previous SR/RT and MS, three previous surgery only. Traintime values and distribution was compared to published thresholds and to 77 patients who underwent first surgery for VS during the same time period.

Results

A-trains were recorded early after opening of the dura, before facial nerve preparation. Mean traintime was 46.9 s (18.51 s – 80.82 s) in patients with previous SR/RT. In patients with previous MS only, traintime was 0.06 s, 0.99 s and 22.46 s. Compared to the literature, traintime was higher than expected in six patients (four with previous SR/RT, two without), respectively seven compared to the 77 patients with first surgery (5 SR/RT). Seven patients with previous SR/RT and none with previous surgery showed diffuse A-train distributions without significant percentages in single channels, compared to 60 of 77 patients with first surgery (p < 0.02).

Conclusions

Especially SR/RT, but also previous surgery seems to induce changes in the facial nerve leading to hyperexcitability and exceedingly high traintime values. Based on these findings, A-train monitoring in this specific patient group should be interpreted with caution.

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Acknowledgments

The study was supported by the Deutsche Forschungsgemeinschaft (DFG PR 1275/1-1) and the Wilhelm-Roux-Program of the University Hospital Halle (Saale).

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany

    S. Rampp, C. Strauss, C. Scheller, J. Rachinger & J. Prell

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  1. S. Rampp
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  2. C. Strauss
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  3. C. Scheller
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  4. J. Rachinger
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  5. J. Prell
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Corresponding author

Correspondence to S. Rampp.

Additional information

Comment

The authors have performed an interesting study examining A-rain responses from the facial nerve during dissection of recurrent vestibular schwannomas. They note extended lengths of A-train activity in this group (especially those treated with radiation) without correlation to postoperative facial nerve outcome. The paper contains some novel information that will be of interest to the readership. The weakness of the paper is the small number of patients studied, but this observation should promote other similar studies. It provides some useful information for the surgeon when operating on recurrent tumors. The authors should be commended on their contribution.

William T Couldwell

Utah, USA

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Rampp, S., Strauss, C., Scheller, C. et al. A-trains for intraoperative monitoring in patients with recurrent vestibular schwannoma. Acta Neurochir 155, 2273–2279 (2013). https://doi.org/10.1007/s00701-013-1891-x

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  • DOI: https://doi.org/10.1007/s00701-013-1891-x

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