The authors have no funding, financial relationships, or conflicts of interest to disclose.
Facial nerve prognostication in vestibular schwannoma surgery: The concept of percent maximum and its predictability
Version of Record online: 15 MAR 2013
Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.
Volume 123, Issue 10, pages 2533–2538, October 2013
How to Cite
Arnoldner, C., Mick, P., Pirouzmand, F., Houlden, D., Lin, V. Y. M., Nedzelski, J. M. and Chen, J. M. (2013), Facial nerve prognostication in vestibular schwannoma surgery: The concept of percent maximum and its predictability. The Laryngoscope, 123: 2533–2538. doi: 10.1002/lary.24083
- Issue online: 23 SEP 2013
- Version of Record online: 15 MAR 2013
- Manuscript Accepted: 8 FEB 2013
- Manuscript Revised: 1 FEB 2013
- Manuscript Received: 10 JAN 2013
- Acoustic neuroma;
- facial nerve function;
- prognostic factor
To evaluate percent maximum as an intraoperative facial nerve measurement for the long-term prognostication of vestibular schwannoma surgery.
Prospective cohort study.
Evoked amplitude responses to varying levels of stimulus intensity at the nerve root were compared to their supramaximal responses (Mmax) as a percentage, that is, percent maximum. Response charts were constructed for each of the levels of stimulus intensity between 0.05 to 0.3 mA, vis-à-vis facial nerve outcome at 1 year, to establish sensitivities, specificities, and positive predictive values. Logistic regression analyses were used to determine the impact of sex, age, tumor size, and historically defined response parameter on outcomes.
Seventy-eight patients who underwent vestibular schwannoma surgeries between 2005 and 2010 were studied. The positive predictive value (PPV) of a good facial nerve outcome, defined as House-Brackmann (HB) I-II, increases with percent maximum responses. A 90% PPV could be established when the response amplitude was 50% or greater compared to Mmax. Long-term prognostication appeared best at a higher stimulus level of 0.3 mA. Age and sex did not have an impact on outcome, but tumor size did; with each centimeter increase in tumor size, patients were 105% more likely to have a poor outcome (HB III-VI). If the response parameter “≥240 μV at 0.05 mA” was not present, there was a trend toward poor outcome.
Percent maximum is a valid intraoperative monitoring measure to prognosticate long-term facial nerve outcome. It should be considered a complementary method of monitoring when evoked responses do not conform to conventional predictors.
Level of Evidence
4. Laryngoscope, 123:2533–2538, 2013