Neurophysiologic monitoring in posterior fossa surgery. II. BAEP-waves I and V and preservation of hearing.

Of 135 cases operated upon for posterior fossa lesions 103 showed preoperative hearing. In 34 acoustic neurinomas 14 had postoperative initially preserved hearing, in 20 microvascular decompressions 19 had preserved postoperative hearing and in 49 other lesions 5 lost hearing. The relationship between preservation of hearing and the preservation or loss of brainstem auditory evoked potentials (BAEP) waves I and V in the three groups of namely: acoustic neurinomas, microvascular decompressions and other lesions are presented. It is noteworthy that only patients with preserved waves I or V are suitable candidates for intraoperative monitoring. The loss of wave V is usually associated with hearing loss (10 out of 13 cases). But hearing loss is also possible despite preservation of wave I (3 out of 60) or despite preservation of wave V (2 out of 68). The predictive value of the preservation of waves I and V is not an absolute one, but it strongly suggests preserved hearing postoperatively. The dilemma remains that once waves I or V are lost during surgery there is no certainty as to postoperative hearing. If wave V recovers after an initial loss, hearing is usually preserved but not in all cases. In wave I amplitude changes alone were more frequent than in wave V, where latency changes alone were more frequently observed. Particular surgical manoeuvres could be found to be often associated with a wave deterioration. Hearing preservation could never be achieved in patients who already preoperatively had no BAEP. It is concluded that BAEP monitoring is of great value in surgery for microvascular decompression and cerebello-pontine-angle (CPA) tumours with preserved hearing.