J Neurol Surg B Skull Base 2016; 77 - PO-01
DOI: 10.1055/s-0036-1592647

Neurophysiological Identification of Cranial Nerves during Endoscopic Endonasal Surgery of Skull Base Tumors

Alexey Shkarubo 1, Anna Ogurtsova 2, Dmitriy Moshchev 3, Dmitriy Andreev 1, Konstantin Koval 1, Ilia Chernov 4
  • 1Department of Neurooncology, the N.N. Burdenko Neurosurgery Institute, Moscow, Russian Federation
  • 2Department of Neurophysiology, the N.N. Burdenko Neurosurgery Institute, Moscow, Russian Federation
  • 3Department of Anesthesiology and Reanimatology, the N.N. Burdenko Neurosurgery Institute, Moscow, Russian Federation
  • 4The I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation

Objective: Prevention of iatrogenic injuries of cranial nerves without reduction of extent of surgical removal of skull base tumors.

Methods: Nine patients were operated on by endoscopic endonasal approach within 2-year period: large skull base chordomas (six cases) and trigeminal neurinomas located in cavernous sinus (three cases). During the surgeries the identification of cranial nerves was performed using t-EMG with bipolar method. The assessment of functional activity of cranial nerves was made both before and after tumor removal.

Results: In seven cases, the tumor removal was estimated as total, and in two cases, the tumor removal was estimated as subtotal (chordomas). Third (four patients), fifth (two patients), and sixth (seven patients) cranial nerves were identified intraoperatively. There were no cases of postoperative functional impairment of these cranial nerves. In one case we were unable to get the response of fourth cranial nerve during surgery, and observed its postoperative plegia (the nerve function was normal before surgery).

Conclusion: T-EMG is a promising method of intraoperative neuromonitoring which needs further investigation.