A Real-Time Monitoring System for the Facial Nerve

• DOI: 10.1227/01.neu.0000369605.79765.3e
• Publication Date: 2010-04-08T06:53:39Z
• Authors: Julian Prell; Jens Rachinger; Christian Scheller; Alex Alfieri; Christian Strauss; Stefan Rampp
• Keywords: Adult; Facial Nerve Injuries; Male; Electromyography; Signal Processing, Computer-Assisted; Middle Aged; Neurosurgical Procedures; Electronics, Medical; Facial Nerve; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Monitoring, Intraoperative; Humans; Female; Prospective Studies; Intraoperative Complications; Software; Aged

Damage to the facial nerve during surgery in the cerebellopontine angle is indicated by A-trains, a specific electromyogram pattern. These A-trains can be quantified by the parameter "traintime," which is reliably correlated with postoperative functional outcome. The system presented was designed to monitor traintime in real-time.A dedicated hardware and software platform for automated continuous analysis of the intraoperative facial nerve electromyogram was specifically designed. The automatic detection of A-trains is performed by a software algorithm for real-time analysis of nonstationary biosignals. The system was evaluated in a series of 30 patients operated on for vestibular schwannoma.A-trains can be detected and measured automatically by the described method for real-time analysis. Traintime is monitored continuously via a graphic display and is shown as an absolute numeric value during the operation. It is an expression of overall, cumulated length of A-trains in a given channel; a high correlation between traintime as measured by real-time analysis and functional outcome immediately after the operation (Spearman correlation coefficient [rho] = 0.664, P < .001) and in long-term outcome (rho = 0.631, P < .001) was observed.Automated real-time analysis of the intraoperative facial nerve electromyogram is the first technique capable of reliable continuous real-time monitoring. It can critically contribute to the estimation of functional outcome during the course of the operative procedure.