Abstract
BackgroundPreservation of anatomic integrity and function of the cranial nerves during the removal of skull base tumors is one of the most challenging procedures in endoscopic endonasal surgery. It is possible to use intraoperative mapping and identification of the cranial nerves in order to facilitate their preservation.The purpose of this study was to evaluate the effectiveness of intraoperative trigger electromyography in prevention of iatrogenic damage to the cranial nerves.MethodsTwenty three patients with various skull base tumors (chordomas, neuromas, pituitary adenomas, meningiomas, cholesteatomas) underwent mapping and identification of cranial nerves during tumor removal using the endoscopic endonasal approach in Department of Neurooncology of Federal State Autonomous Institution “N.N. Burdenko National Medical Research Center of Neurosurgery” of the Ministry of Health of the Russian Federation from 2013 to 2018. During the surgical interventions, mapping and identification of the cranial nerves were carried out using electromyography in triggered mode. The effectiveness of the method was evaluated based on a comparison with a control group (41 patients).ResultsIn the main group of patients, 44 nerves were examined during surgery using triggered electromyography. During the study, the III, V, VI, VII, and XII cranial nerves were identified intraoperatively. Postoperative cranial nerve deficiency was observed in 5 patients in the study group and in 13 patients in the control group. The average length of hospitalization was 9 days.ConclusionWe did not receive statistically significant data supporting the fact that intraoperative identification of cranial nerves using trigger electromyography reduces the incidence of postoperative complications in the form of cranial nerve deficits (p = 0.56), but the odds ratio (0.6) suggests a less frequent occurrence of complications in the study group.Based on our experience, the trigger electromyography methodology appears quite promising and requires further research.
Highlights
Over the last 30 years, the microsurgical transsphenoidal approach has been widely used for removal of skull base tumors [1,2,3,4]
Because of the intimate proximity between the structures of the base of the skull and the neurovascular structures, even minimally invasive endoscopic endonasal surgical interventions are associated with the potential risk of their iatrogenic damage, which can lead to a decrease in the quality of life of the patients [23,24,25]
For the purposes of this study, we used triggered electromyography (t-EMG) for intraoperative mapping and identification of cranial nerves during endoscopic endonasal surgery of skull base tumors
Summary
Over the last 30 years, the microsurgical transsphenoidal approach has been widely used for removal of skull base tumors [1,2,3,4]. With the development of endoscopic technologies, the endoscopic endonasal transsphenoidal approach has become the gold standard for surgical removal of central skull base tumors [5,6,7,8,9]. The frequency of iatrogenic cranial nerve injuries in skull base surgery using different methods of intraoperative identification ranges from 2% to 47% [11,12,13,14]. The incidence of cranial nerve injury has been reported to range from 14% to 68% [12, 15]. Preservation of anatomic integrity and function of the cranial nerves during the removal of skull base tumors is one of the most challenging procedures in endoscopic endonasal surgery. The purpose of this study was to evaluate the effectiveness of intraoperative trigger electromyography in prevention of iatrogenic damage to the cranial nerves
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