Application value of brainstem auditory evoked potential in microvascular decompression of facial spasm

doi:10.3877/cma.j.issn.2095-9141.2022.02.005

Abstract

Abstract:

Objective

To investigate the correlation between changes in brainstem auditory evoked potentials (BAEPs) Ⅴ wave latency and (or) amplitude and hearing loss (HL) after hemifacial spasm (HFS) microvascular decompression (MVD).

Methods

The clinical data of HFS patients treated with MVD in Neurosurgery Department of China-Japan Friendship Hospital from September 2015 to August 2019 were selected to analyze the changes of V-wave latency and amplitude of BAEPs before and after MVD as well as the changes of hearing status before and after MVD. Audiology was evaluated by mean pure tone hearing threshold and speech recognition rate changes. According to the AAO-HNS grading method, the postoperative patients' hearing was divided into non significant HL group and significant HL group. BAEPs changes in the whole intraoperative process were collected, and V-wave intraoperative changes of BAEPs were divided into: no significant abnormality, simple V wave latency (LwV) prolonged >1.5 ms, simple V wave amplitude (AwV) decreased >50%, prolonged >1.5 ms and AwV decreased >50%, LwV prolonged >1.5 ms or AwV decreased >50%. The correlation between the degree of postoperative hearing injury and grouping under the five group classification mode was statistically analyzed, and the predictive value of BAEPs changes on postoperative HL in the four groups was statistically analyzed.

Results

Among 1009 HFS patients who underwent MVD, 943 patients had no significant HL, 66 patients had abnormal hearing after surgery, the waveforms of BAEPs monitoring had no significant change during surgery, and 5 patients (0.6%) had HL after surgery. Intraoperative LwV was prolonged >1.5 ms, and 4 cases (18.2%) had postoperative HL. Intraoperative AwV decreased by more than 50%, and postoperative HL occurred in 19 cases (25.0%). Intraoperative LwV prolonged >1.5 ms and AwV decreased >50%, and postoperative HL occurred in 38 cases (64.4%). Intraoperative LwV prolonged >1.5 ms or AwV decreased >50%, and postoperative HL occurred in 61 cases (38.8%). In addition, positive predictive value of each group was compared. The results showed that "1.5 ms extension of LwV and over 50% reduction of AwV" was the highest. The group "intraoperativLewV prolonged >1.5 ms and AwV decreased >50%" had the highest sensitivity. The group "1.5 ms extension of LwV and over 50% reduction of AwV" had the most strong specificity

Conclusion

Intraoperative BAEPs monitoring can provide reference for MVD patients. The positive prediction of V-wave latency prolonged by 1.5 ms and wave amplitude decreased by more than 50% at the end of operation was the highest among the four groups. In addition, timely adjustment of surgical strategies according to BAEPs monitoring results during surgery can effectively improve the incidence of postoperative hearing impairment.

Key words: Hemifacial spasm, Brainstem auditory evoked potential, Microvascular decompression, Hearing loss

Hongxiang Ren, Li Zhang, Yulian Zhang, Xuelai Liu, Yanbing Yu. Application value of brainstem auditory evoked potential in microvascular decompression of facial spasm[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(02): 87-91.

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References 15

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项目		听力未明显下降组（n=943）	听力明显下降组（n=66）	χ²/t值	P值
性别（女/男）		564/379	39/27	0.013	0.908
年龄（岁，±s）		50.2±11.5	52.3±11.5	-1.431	0.153
侧别（左/右）		452/491	31/35	0.023	0.880
高血压[例（%）]		135（14.3）	12（18.2）	0.741	0.389
糖尿病[例（%）]		71（7.5）	4（6.0）	0.039	0.844
责任血管[例（%）]				2.530	0.470
	AICA	544（57.7）	34（51.5）
	PICA	202（21.4）	15（22.7）
	AICA+PICA	119（12.6）	8（12.1）
	VA+AICA/PICA	78（8.3）	9（13.6）

项目		听力未明显下降组（n=943）	听力明显下降组（n=66）	χ²/t值	P值
性别（女/男）		564/379	39/27	0.013	0.908
年龄（岁，±s）		50.2±11.5	52.3±11.5	-1.431	0.153
侧别（左/右）		452/491	31/35	0.023	0.880
高血压[例（%）]		135（14.3）	12（18.2）	0.741	0.389
糖尿病[例（%）]		71（7.5）	4（6.0）	0.039	0.844
责任血管[例（%）]				2.530	0.470
	AICA	544（57.7）	34（51.5）
	PICA	202（21.4）	15（22.7）
	AICA+PICA	119（12.6）	8（12.1）
	VA+AICA/PICA	78（8.3）	9（13.6）

组别	例数	听力下降[例（%）]	敏感度	特异度	阳性预测值	阴性预测值	阳性似然比	阴性似然比
无显著改变	852	5（0.6）
LwV延长>1.5 ms	22	4（18.2）	0.06	0.98	0.18	0.94	3.18	0.96
AwV下降>50%	76	19（25.0）	0.29	0.94	0.25	0.95	4.76	0.76
LwV延长>1.5 ms且AwV下降>50%	59	38（64.4）	0.58	0.98	0.64	0.97	25.85	0.43
LwV延长>1.5 ms或AwV下降>50%	157	61（38.8）	0.92	0.89	0.39	0.99	9.08	0.08

组别	例数	听力下降[例（%）]	敏感度	特异度	阳性预测值	阴性预测值	阳性似然比	阴性似然比
无显著改变	852	5（0.6）
LwV延长>1.5 ms	22	4（18.2）	0.06	0.98	0.18	0.94	3.18	0.96
AwV下降>50%	76	19（25.0）	0.29	0.94	0.25	0.95	4.76	0.76
LwV延长>1.5 ms且AwV下降>50%	59	38（64.4）	0.58	0.98	0.64	0.97	25.85	0.43
LwV延长>1.5 ms或AwV下降>50%	157	61（38.8）	0.92	0.89	0.39	0.99	9.08	0.08

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