METHODS: We performed parotidectomies with anterograde facial nerve visualization using cIONM in 32 consecutive patients in a prospective study (German Register of clinical studies-DRKS 00011051) during the period October 2016 to January 2020. After the facial trunk had been exposed, an atraumatic stimulation electrode was placed and the nerve was stimulated at 3 Hz, at a low threshold (0.62 ± 0.06 mA), for the entire duration of the preparation. Selected electrophysiological parameters were collected and compared to postoperative facial nerve function, measured by the House-Brackmann grading system.
RESULTS: In the post hoc analysis, a significant correlation between a drop in amplitude (< 50% of the \"baseline\" amplitude) and postoperative FP was recorded (p = 0.001). True positive prediction of FP was noted in 14 out of 16 patients and true negative in 10 out of 16. The sensitivity was 87.5% (AUC 0.75), with a high negative predictive value of 83.3%.
CONCLUSIONS: cIONM has significant value in predicting postoperative FP in parotidectomy. Future development of an acoustic/optic warning system in IONM devices could prevent nerve injury in real time.
方法:我们在一项前瞻性研究(德国临床研究注册-DRKS00011051)中,在2016年10月至2020年1月期间,对32名连续患者使用cIONM进行了顺行面神经可视化腮腺切除术。面部躯干暴露后,放置无创伤刺激电极,并以3Hz刺激神经,在低阈值(0.62±0.06mA)下,在整个准备过程中。收集选定的电生理参数,并与术后面神经功能进行比较,由House-Brackmann分级系统测量。
结果:在事后分析中,记录到振幅下降(<"基线"振幅的50%)与术后FP之间存在显著相关性(p=0.001).在16例患者中有14例发现了FP的真阳性预测,在16例患者中有10例发现了真阴性。灵敏度为87.5%(AUC0.75),具有83.3%的高阴性预测值。
结论:cIONM对预测腮腺切除术后FP有重要价值。IONM设备中声学/光学警告系统的未来发展可以实时防止神经损伤。