Intraoperative Cranial Nerve Monitoring In Vestibular Schwannoma Surgery

Publication Date: February 1, 2018
Last Updated: March 14, 2022

Recommendations

FACIAL NERVE MONITORING

It is recommended that intraoperative facial nerve monitoring be routinely utilized during vestibular schwannoma surgery to improve long-term facial nerve function. (Level III)
318512
Intraoperative facial nerve can be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery. Specifically, the presence of favorable testing reliably portends a good long-term facial nerve outcome. However, the absence of favorable testing in the setting of an anatomically intact facial nerve does not reliably predict poor long-term function and therefore cannot be used to direct decision-making regarding the need for early reinnervation procedures. (Level III)
318512
Poor intraoperative EMG electrical response of the facial nerve should not be used as a reliable predictor of poor long-term facial nerve function. (Level III)
318512

COCHLEAR NERVE MONITORING

Intraoperative eighth cranial nerve monitoring should be used during vestibular schwannoma surgery when hearing preservation is attempted. (Level III)
318512
There is insufficient evidence to make a definitive recommendation regarding the superiority of direct monitoring of the eighth cranial nerve over the use of far-field auditory brain stem responses. (Level III)
318512

Recommendation Grading

Overview

Title

Intraoperative Cranial Nerve Monitoring In Vestibular Schwannoma Surgery

Authoring Organization

Congress of Neurological Surgeons

Publication Month/Year

February 1, 2018

Last Updated Month/Year

August 7, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

 There is a need to assess the existing literature for vestibular schwannoma surgery outcomes, specifically as it relates to the use of intraoperative cranial nerve monitoring and its impact on postoperative facial nerve function and hearing preservation

Target Patient Population

Patients undergo vestibular schwannoma surgery

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management

Diseases/Conditions (MeSH)

D013502 - General Surgery, D015837 - Vestibular Diseases, D016343 - Monitoring, Intraoperative, D012583 - Schwann Cells, D003391 - Cranial Nerves, D004594 - Electrophysiology, D004576 - Electromyography, D005154 - Facial Nerve

Keywords

facial nerve, intraoperative monitoring, vestibular schwannomas

Source Citation

Neurosurgery, Volume 82, Issue 2, February 2018, Pages E44–E46, https://doi.org/10.1093/neuros/nyx513

Supplemental Methodology Resources

Systematic Review Document

Methodology

Number of Source Documents
37
Literature Search Start Date
January 1, 1990
Literature Search End Date
December 31, 2014