Intraoperative monitoring of lower cranial nerves in surgery of the skull base

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Intraoperative electromyographic monitoring of the facial nerve is now recognized as a beneficial adjunct to facial nerve preservation in surgery for vestibular schwannomas. With advances in surgical treatment of lesions involving the posterolateral skull base, monitoring of other lower cranial nerves has rapidly evolved. Electromyographic data assist in cranial nerve identification, preservation, and estimation of nerve outcome. Implementation of procedures and protocol should be established by surgical team members. Technology currently provides the ability to monitor real-time electromyographic responses both visually and audibly. Monitoring and stimulation methods for facial and lower cranial nerves are presented. Intraoperative electromyographic monitoring of the facial nerve is now recognized as a beneficial adjunct to facial nerve preservation in surgery for vestibular schwannomas. With advances in surgical treatment of lesions involving the posterolateral skull base, monitoring of other lower cranial nerves has rapidly evolved. Electromyographic data assist in cranial nerve identification, preservation, and estimation of nerve outcome. Implementation of procedures and protocol should be established by surgical team members. Technology currently provides the ability to monitor real-time electromyographic responses both visually and audibly. Monitoring and stimulation methods for facial and lower cranial nerves are presented.