Department of Neurology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.
Department of Neurology, Acibadem Altunizade Hospital, Istanbul, Turkey.
J Clin Neurophysiol. 2022 May 1;39(4):299-306. doi: 10.1097/WNP.0000000000000777. Epub 2020 Sep 28.
Blink reflex (BR) under general anesthesia as an intraoperative neuromonitoring method was used to monitor facial nerves in few studies. This study aimed to test the utility of intraoperative BR during cerebellopontine angle and skull base surgeries, assess its prognostic value for facial nerve functions, and compare it with facial corticobulbar motor evoked potentials (CoMEPs).
Blink reflex and facial CoMEPs were recorded from 40 patients undergoing skull base surgeries. Subdermal needles were placed in the supraorbital notch for stimulation and in the orbicularis oculi muscle for recording the BR. A double train of 20 to 40 V intensity with an intertrain interval of 40 to 60 milliseconds, an interstimulus interval of 2.5 milliseconds, and a stimulus duration of 0.5 milliseconds were applied. Facial nerve functions were assessed with the House-Brackmann grading system in the postoperative day 1 and third-month period and correlated with intraoperative BR and CoMEPs measurements.
Of 40 patients, BR was recordable on the affected side in 32 (80%) and contralateral side in 35 (87.5%) patients. According to our statistical results, BR had a slightly better sensitivity than facial CoMEPs in predicting impairment of facial nerve functions for both postoperative and third-month time points. Blink reflex showed better accuracy for predicting postoperative nerve functions, whereas CoMEPs correlated better in predicting third-month outcome.
We suggest that BR is a valuable intraoperative neuromonitoring method that can be used in addition to facial CoMEPs during skull base surgeries to assess real-time facial nerve integrity and predict prognosis.
在全身麻醉下使用眨眼反射（BR）作为术中神经监测方法，已有少数研究用于监测面神经。本研究旨在测试术中 BR 在桥小脑角和颅底手术中的应用价值，评估其对面神经功能的预后价值，并将其与面皮质脊髓运动诱发电位（CoMEPs）进行比较。
记录 40 例行颅底手术患者的眨眼反射和面部 CoMEPs。在眶上切迹处放置皮下针进行刺激，在眼轮匝肌处放置针进行记录 BR。应用强度为 20-40V、刺激间隔为 40-60 毫秒、刺激间隔为 2.5 毫秒、刺激持续时间为 0.5 毫秒的双串刺激。术后第 1 天和第 3 个月采用 House-Brackmann 分级系统评估面神经功能，并与术中 BR 和 CoMEPs 测量值相关联。
40 例患者中，32 例（80%）受影响侧和 35 例（87.5%）对侧可记录到 BR。根据我们的统计结果，BR 在预测面神经功能损伤方面的敏感性略优于面部 CoMEPs，无论是术后还是第 3 个月。BR 对面神经术后功能的预测准确性较好，而 CoMEPs 对面神经第 3 个月预后的预测相关性较好。
我们认为 BR 是一种有价值的术中神经监测方法，可与颅底手术中的面部 CoMEPs 联合使用，以评估面神经实时完整性并预测预后。
