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

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

Research output: Contribution to journalArticle

13 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

Fingerprint

Facial Nerve
Electromyography
Facial Muscles
Carotid Artery Injuries
Mechanical Stress
Facial Paralysis
Internal Carotid Artery

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

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title = "Usefulness of facial nerve monitoring for confirmation of greater superficial petrosal nerve in anterior transpetrosal approach",
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.",
keywords = "Anterior transpetrosal approach, Dry eye, Greater petrosal nerve, Greater superficial petrosal nerve, Intraoperative monitoring, Kawase’s triangle, Monitoring",
author = "Ryosuke Tomio and Takenori Akiyama and Takayuki Oohira and Tomo Horikoshi and Kazunari Yoshida",
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T1 - Usefulness of facial nerve monitoring for confirmation of greater superficial petrosal nerve in anterior transpetrosal approach

AU - Tomio, Ryosuke

AU - Akiyama, Takenori

AU - Oohira, Takayuki

AU - Horikoshi, Tomo

AU - Yoshida, Kazunari

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

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KW - Monitoring

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