Unit of Intraoperative Neurophysiology, Department of Neurology, University hospital of Bellvitge, Barcelona, Spain.
Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States.
Handb Clin Neurol. 2022;186:163-176. doi: 10.1016/B978-0-12-819826-1.00016-8.
Cerebellopontine angle (CPA) surgery represents a challenge for neurosurgeons due to the high risk of iatrogenic injury of vital neurological structures. Therefore, important efforts in improving the surgical techniques and intraoperative neurophysiology have been made in the last decades. We present a description and review of the available methodologies for intraoperative neuromonitoring and mapping during CPA surgeries. There are three main groups of techniques to assess the functional integrity of the nervous structures in danger during these surgical procedures: (1) Electrical identification or mapping of motor cranial nerves (CNs), which is essential in order to locate the nerve in their different parts during the tumor resection; (2) Monitoring, which provides real-time information about functional integrity of the nervous tissue; and (3) Brainstem reflexes including blink reflex, masseteric reflex, and laryngeal adductor reflex. All these methods facilitate the removal of lesions and contribute to notable improvement in functional outcome and permit on the investigation of their physiopathology in certain neurosurgically treated diseases. Such is the case of hemifacial spasm (HFS). We describe the methodology to evaluate the efficacy of microvascular decompression for HFS treatment at the end of this chapter.
桥小脑角（CPA）手术对神经外科医生来说是一个挑战，因为存在医源性损伤重要神经结构的高风险。因此，在过去几十年中，人们在改进手术技术和术中神经生理学方面做出了重要努力。我们介绍了用于 CPA 手术期间术中神经监测和映射的现有方法。有三种主要的技术组来评估这些手术过程中处于危险中的神经结构的功能完整性：（1）对运动颅神经（CN）进行电识别或映射，这对于在肿瘤切除过程中在其不同部位定位神经至关重要；（2）监测，它提供有关神经组织功能完整性的实时信息；以及（3）脑干反射，包括眨眼反射、咬肌反射和喉内收反射。所有这些方法都有助于切除病变，并显著改善功能预后，并允许对某些经神经外科治疗的疾病的病理生理学进行研究。面肌痉挛（HFS）就是这种情况。我们在本章末尾描述了评估微血管减压治疗 HFS 效果的方法。
