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Intraoperative monitoring of the facial nerve by automated categorisation of EMG-activity

通过肌电图活动自动分类来术中监测面神经

基本信息

批准号：
183849231
负责人：
Professor Dr. Julian Prell
金额：
--
依托单位：
Universitätsklinik und Poliklinik für Neurochirurgie
依托单位国家：
德国
项目类别：
Research Grants
财政年份：
2010
资助国家：
德国
起止时间：
2009-12-31 至 2019-12-31
项目状态：
已结题

来源：
https://gepris.dfg.de/gepris/projekt/183849231?language=en
关键词：
Intraoperative monitoring facial nerve automated

项目摘要

During surgery for vestibular schwannoma, the facial nerve can be monitored by intraoperative evaluation of the EMG from the facial muscles. With this method, particular patterns (A-trains) signify potential damage to the facial nerve. A quantitative correlation between the amount of observed A-trains activity and the degree of clinical postoperative impairment has been demonstrated. However, false negative (very few A-trains, significant postoperative deficits) and false positive results (many A-trains, few clinical deficits) have been shown to impair the reliability of the method. In the context of our first application (PR1275/1-1), methods for automated analysis of the facial nerve EMG have been developed and evaluated. It was our main goal to identify the sources of false positive and false negative results. This goal was accomplished. In accord with our assumptions, false negative findings were shown to be based on too small a sample with too small an amount of electrodes utilized. In addition, we were able to demonstrate in a consecutive series of papers published in highly ranking journals that intraoperative manipulation of the Intermedius Nerve may lead to additional pathological A-trains without a postoperative clinical correlate; thus, this intermedius nerve activity acts as an interfering signal in the context of facial nerve monitoring. This follow-up application is based on the findings as outlined above. Its goal is to develop and evaluate methods which may technically differentiate between real facial nerve A-trains and A-trains elicited by intermedius nerve manipulation in an intraoperative setting. To do so, the respective biosignals will be compared systematically in order to find divergent signal characteristics. In this context, the assumption that intraoperative manipulation of a given motor unit will lead to monomorphic and specific EMG-signals will be followed further, as this would mean that after a certain time, the specific pattern may lose significance, because the corresponding unit cannot be damaged any further. In addition, EMG-analysis will be directly compared with the two other available methods for facial nerve monitoring: Direct electrical stimulation and facial nerve motor evoked potentials. Both methods are also flawed with false positive monitoring results; however, these results should not be based on intermedius nerve activity according to our assumptions. Thus, a complementary approach may lead to new findings in this context. Finally, a technical method for documentation of the facial nerve functional status after surgery is to be evaluated. This method is based on 3D-fotography and supposed to allow for an objective evaluation in contrast to the common method of clinical assessment by paresis grades. Our finding that A-trains elicited by the intermedius nerve tend to be limited to specific parts of the facial muscles can be evaluated further with this method.

在前庭神经鞘瘤手术中，可以通过术中评估面部肌肉的肌电来监测面神经。在这种方法中，特定的模式(A-系列)表示可能对面神经造成损害。观察到的A-系列活动量与临床术后损伤程度之间存在定量的相关性。然而，假阴性(非常少的A-系列，术后明显的缺陷)和假阳性结果(许多A-系列，很少的临床缺陷)已经被证明损害了该方法的可靠性。在我们的第一个应用(PR1275/1-1)的背景下，已经开发和评估了面神经肌电的自动分析方法。识别假阳性和假阴性结果的来源是我们的主要目标。这一目标已经实现。与我们的假设一致，假阴性结果被证明是基于太小的样本和使用的电极量太少。此外，我们能够在连续发表在高排名期刊上的一系列论文中证明，术中操作中间神经可能会导致额外的病理A-系列，而没有术后临床相关性；因此，这种中间神经活动在面神经监测中充当干扰信号。这项后续申请是基于上述调查结果。它的目标是开发和评估在技术上可以区分真正的面神经A-串和术中操作中间神经引起的A-串的方法。为此，将系统地比较各个生物信号，以找出不同的信号特征。在这种情况下，将进一步遵循术中操作给定运动单元将导致单态和特定EMG信号的假设，因为这将意味着在特定时间之后，特定模式可能失去意义，因为相应的单元不能再受到任何损害。此外，肌电分析将直接与其他两种面神经监测方法进行比较：直接电刺激和面神经运动诱发电位。这两种方法都有假阳性监测结果的缺陷；然而，根据我们的假设，这些结果不应该基于中间神经活动。因此，补充办法可能会在这方面产生新的结论。最后，对记录手术后面神经功能状态的技术方法进行评估。这种方法是基于三维足底成像，并被认为允许客观的评估，而不是通常的临床评估方法，通过轻瘫分级。我们的发现，由中间神经诱发的A-系列往往局限于面部肌肉的特定部分，可以用这种方法进一步评估。