Pharyngeal Motor Evoked Potential Monitoring During Skull Base Surgery Predicts Postoperative Recovery from Swallowing Dysfunction

Abstract

Monitoring pharyngeal motor evoked potential (PhMEP) with a modified endotracheal tube is useful for predicting postoperative swallowing dysfunction. However, the relationship between intraoperative PhMEP findings and recovery from postoperative swallowing dysfunction has not been clarified. The aim of this study was to determine whether PhMEP monitoring predicts swallowing dysfunction not only immediately after surgery but also in the postoperative recovery period. We analyzed PhMEPs in 36 patients during treatment for skull base tumors. Recovery from postoperative swallowing dysfunction was evaluated when oral intake was started postsurgery and drip or tube feeding was discontinued. The correlation between the final to baseline PhMEP ratio and postoperative recovery times from swallowing dysfunction was examined. The PhMEP ratio significantly correlated with postoperative swallowing function immediately after surgery (P < 0.001). The period before starting oral intake in patients with a PhMEP ratio >50% (mean ± standard deviation [SD], 3.8 ± 4.3 days) was shorter than those with a PhMEP ratio ≤50% (mean ± SD, 14.7 ± 11.8 days; P < 0.01). Drip or tube feeding was removed from patients with a PhMEP ratio >50% significantly earlier (mean ± SD, 13.7 ± 19.2 days) than those with a PhMEP ratio ≤50% (mean ± SD, 38.3 ± 27.3 days; P < 0.05). Both univariate and multivariate analysis showed that only the PhMEP ratio was predictive of early recovery from swallowing dysfunction. PhMEP monitoring allowed us to predict not only immediate swallowing dysfunction but also recovery from the dysfunction in the postsurgery period.