TY - JOUR
T1 - A Study on the Role of Intraoperative Corticobulbar Motor Evoked Potentials for Improving Safety of Cerebellopontine Angle Surgery in Elderly Patients
AU - D'Alessandris, Quintino Giorgio
AU - Menna, Grazia
AU - Stifano, Vito
AU - Della Pepa, Giuseppe Maria
AU - Burattini, Benedetta
AU - Di Domenico, Michele
AU - Izzo, Alessandro
AU - D'Ercole, Manuela
AU - Lauretti, Liverana
AU - Montano, Nicola
AU - Olivi, Alessandro
PY - 2023
Y1 - 2023
N2 - Preservation of facial nerve function (FNF) during neurosurgery for cerebellopontine angle (CPA) tumors is paramount in elderly patients. Corticobulbar facial motor evoked potentials (FMEPs) allow assessment intraoperatively of the functional integrity of facial motor pathways, thus improving safety. We aimed to evaluate the significance of intraoperative FMEPs in patients 65 years and older. A retrospective cohort of 35 patients undergoing CPA tumors resection was reported; outcomes of patients aged 65–69 years vs. ≥70 years were compared. FMEPs were registered both from upper and lower face muscles, and amplitude ratios (minimum-to-baseline, MBR; final-to-baseline, FBR; and recovery value, FBR minus MBR) were calculated. Overall, 78.8% of patients had a good late (at 1 year) FNF, with no differences between age groups. In patients aged ≥70 years, MBR significantly correlated with late FNF. At receiver operating characteristics (ROC) analysis, in patients aged 65–69 years, FBR (with 50% cut-off value) could reliably predict late FNF. By contrast, in patients aged ≥70 years, the most accurate predictor of late FNF was MBR, with 12.5% cut-off. Thus, FMEPs are a valuable tool for improving safety in CPA surgery in elderly patients as well. Considering literature data, we noticed higher cut-off values for FBR and a role for MBR, which suggests an increased vulnerability of facial nerves in elderly patients compared to younger ones.
AB - Preservation of facial nerve function (FNF) during neurosurgery for cerebellopontine angle (CPA) tumors is paramount in elderly patients. Corticobulbar facial motor evoked potentials (FMEPs) allow assessment intraoperatively of the functional integrity of facial motor pathways, thus improving safety. We aimed to evaluate the significance of intraoperative FMEPs in patients 65 years and older. A retrospective cohort of 35 patients undergoing CPA tumors resection was reported; outcomes of patients aged 65–69 years vs. ≥70 years were compared. FMEPs were registered both from upper and lower face muscles, and amplitude ratios (minimum-to-baseline, MBR; final-to-baseline, FBR; and recovery value, FBR minus MBR) were calculated. Overall, 78.8% of patients had a good late (at 1 year) FNF, with no differences between age groups. In patients aged ≥70 years, MBR significantly correlated with late FNF. At receiver operating characteristics (ROC) analysis, in patients aged 65–69 years, FBR (with 50% cut-off value) could reliably predict late FNF. By contrast, in patients aged ≥70 years, the most accurate predictor of late FNF was MBR, with 12.5% cut-off. Thus, FMEPs are a valuable tool for improving safety in CPA surgery in elderly patients as well. Considering literature data, we noticed higher cut-off values for FBR and a role for MBR, which suggests an increased vulnerability of facial nerves in elderly patients compared to younger ones.
KW - cerebellopontine angle surgery
KW - elderly
KW - facial motor evoked potentials
KW - intraoperative neurophysiological monitoring
KW - cerebellopontine angle surgery
KW - elderly
KW - facial motor evoked potentials
KW - intraoperative neurophysiological monitoring
UR - http://hdl.handle.net/10807/227188
U2 - 10.3390/diagnostics13040710
DO - 10.3390/diagnostics13040710
M3 - Article
SN - 2075-4418
VL - 13
SP - 710-N/A
JO - Diagnostics
JF - Diagnostics
ER -