A-train clusters and the intermedius nerve in vestibular schwannoma patients
A-train clusters and the intermedius nerve in vestibular schwannoma patients
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DOI：
10.1016/j.clinph.2019.02.014
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发表时间：
2019-05-01
影响因子：
4.7
通讯作者：
Prell, Julian
中科院分区：
文献类型：
--
作者：
Rampp, Stefan;Illert, Joerg;Prell, Julian
目的：肌电图“A-train”活动与前庭神经鞘瘤 (VS) 手术后的术后面瘫相关。与面神经分离的中间神经可增加 A 训练，但不会对功能产生显着影响。我们调查了 A 列“簇”的发生情况，A 列在短时间内在大多数通道上发生。方法：对 217 名首次接受 VS 手术的患者的数据进行回顾性评估。评估用 9 个通道记录的连续 EMG 的 A 序列模式。识别出 A 列车“集群”，即 3 秒内在大多数频道上出现 A 列车。评估了与单独中间体、肿瘤大小和面瘫的关系。结果：在没有单独中间体的患者中，A 序列与术后面瘫之间的相关性更高（r = 0.562 与 r = 0.194）。在 107 名患者 (49.3%) 中鉴定出簇，在 109 名患者 (50.2%) 中鉴定出独立中间体，两者具有显着相关性（p < 0.001，卡方检验）。排除簇会稍微增加 A-train 与面神经功能的相关性。结论：A-train 簇对于预测术后麻痹的相关性有限。然而，它们应被视为警告信号，表明存在单独的中间神经。意义：A 列“簇”是由于单独的中间神经而导致面神经过度活跃的迹象，可能会混淆 VS 手术期间的术中监测。 (C) 2019 年国际临床神经生理学联合会。由 Elsevier B.V. 出版。保留所有权利。
Objective: EMG "A-train" activity correlates with postoperative facial palsy after vestibular schwannoma (VS) surgery. An intermedius nerve separate from the facial nerve increases A-trains without significant impact on function. We investigate occurrence of A-train "clusters", A-trains over a majority of channels within a short time frame.Methods: Data from 217 patients with first surgery for VS were evaluated retrospectively. Continuous EMG recorded with 9 channels was evaluated for A-train patterns. "Clusters" of A-trains were identified, i.e. A-trains within 3 seconds over a majority of channels. Relation to a separate intermedius, tumor size and facial palsy was evaluated.Results: Correlations between A-trains and postoperative facial palsy were higher in patients without separate intermedius (r= 0.562 versus r= 0.194). Clusters were identified in 107 patients (49.3%), separate intermedius in 109 (50.2%), with significant association of both (p < 0.001, Chi-Square test). Excluding clusters slightly increased correlation of A-trains to facial nerve function.Conclusions: A-train clusters have limited relevance for predicting postoperative paresis. However, they should be regarded as warning signs, suggesting the presence of a separate intermedius nerve.Significance: A-train "clusters" are a sign of hyperactivity of the facial nerve due to a separate intermedius nerve and may confound intraoperative monitoring during VS surgery. (C) 2019 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.