Trigger electromyography in endoscopic transnasal surgery of skull base tumors

Abstract

Introduction . The development of minimally invasive technologies in recent decades has expanded the indications for the use of endoscopic transnasal transsphenoidal approaches in surgery of skull base tumors. It became possible to perform surgical interventions aimed at removing tumors of the base of the skull that spread to the area of the passage of cranial nerves (cavernous sinus, clival area, cerebello-pontine angle), which is associated with the risk of damage to certain cranial nerves. The study objective is to evaluate the effectiveness of trigger electromyography in providing anatomical and functional preservation of cranial nerves during endoscopic endonasal transsphenoidal removal of skull base tumors. Materials and methods . The study is based on statistical analysis and comparison of the results of surgical treatment of two groups of patients with various tumors of the base of the skull: the main group (30 patients with using trigger electromyography to identify cranial nerves intraoperatively) and the control group (43 patients without using this method). The effectiveness and safety of using the method of intraoperative identification of cranial nerves was evaluated based on a comparison of basic characteristics, treatment outcomes, and factors potentially affecting them. Results . Fifty-seven (57) cranial nerves were identified intraoperatively in the main group. The frequency of radical removal was 1.6 times higher in the main group (70 % vs 44.2 %, p = 0.03). When analyzing the dynamics of the state of motor cranial nerves after surgery in the main and control groups, it was shown that negative dynamics prevailed in the control group — 37.2 % vs 13.3 % (p = 0.03), and positive dynamics prevailed in the main group (37.3 % vs 13.9 %), 2.8 times (p = 0.08). Conclusion . The obtained data indicate that the use of the intraoperative identification method in endoscopic transnasal surgery of skull base tumors can positively affect the radical removal of tumors and the preservation of cranial nerve function in the postoperative period.