Usefulness of facial nerve monitoring for confirmation of greater superficial petrosal nerve in anterior transpetrosal approach

Ryosuke Tomio, Takenori Akiyama, Takayuki Ohira, Tomo Horikoshi, Kazunari Yoshida

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction: The greater superficial petrosal nerve (GSPN) is especially important in anterior transpetrosal approach (ATPA) as the most reliable superficial landmark of Kawase’s triangle. The GSPN can be considered as the superficial lateral border of anterior petrosectomy on the middle fossa to avoid internal carotid artery (ICA) injury. Although experienced operators can find the GSPN, its confirmation is not always easy to achieve.

Methods: We introduce our recent GSPN confirmation methods using facial nerve monitoring. In 10 recent cases, antidromic GSPN stimulation and free-running facial muscle electromyography (EMG) monitoring were performed.

Results: Facial nerve evoked-EMG by antidromic GSPN stimulation confirmed the location of the GSPN course with precision in all cases. Free-running facial muscle EMG informed the mechanical stress of facial nerves through the GSPN. There was no postoperative facial palsy or dry eye in these cases.

Conclusions: GSPN confirmation and preservation are not always easy to achieve. These monitoring methods are useful for the confirmation of the GSPN, which is a landmark for safe extradural anterior petrosectomy, and for the preservation of the GSPN itself.

Original languageEnglish
Pages (from-to)1847-1852
Number of pages6
JournalActa Neurochirurgica
Volume156
Issue number10
DOIs
Publication statusPublished - 2014 Jan 1

Keywords

  • Anterior transpetrosal approach
  • Dry eye
  • Greater petrosal nerve
  • Greater superficial petrosal nerve
  • Intraoperative monitoring
  • Kawase’s triangle
  • Monitoring

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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