Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Intraoperative Cranial Nerve Monitoring in Vestibular Schwannoma Surgery

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Abstract

FACIAL NERVE MONITORING

Question 1 Does intraoperative facial nerve monitoring during vestibular schwannoma surgery lead to better long-term facial nerve function?

FACIAL NERVE MONITORING

Target Population This recommendation applies to adult patients undergoing vestibular schwannoma surgery regardless of tumor characteristics.

FACIAL NERVE MONITORING

Recommendation Level 3: It is recommended that intraoperative facial nerve monitoring be routinely utilized during vestibular schwannoma surgery to improve long-term facial nerve function.

FACIAL NERVE MONITORING

Question 2 Can intraoperative facial nerve monitoring be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery?

FACIAL NERVE MONITORING

Target Population This recommendation applies to adult patients undergoing vestibular schwannoma surgery.

FACIAL NERVE MONITORING

Recommendation Level 3: 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.

FACIAL NERVE MONITORING

Question 3 Does an anatomically intact facial nerve with poor electromyogram (EMG) electrical responses during intraoperative testing reliably predict poor long-term facial nerve function?

FACIAL NERVE MONITORING

Target Population This recommendation applies to adult patients undergoing vestibular schwannoma surgery.

FACIAL NERVE MONITORING

Recommendation Level 3: Poor intraoperative EMG electrical response of the facial nerve should not be used as a reliable predictor of poor long-term facial nerve function.

COCHLEAR NERVE MONITORING

Question 4 Should intraoperative eighth cranial nerve monitoring be used during vestibular schwannoma surgery?

COCHLEAR NERVE MONITORING

Target Population This recommendation applies to adult patients undergoing vestibular schwannoma surgery with measurable preoperative hearing levels and tumors smaller than 1.5 cm.

COCHLEAR NERVE MONITORING

Recommendation Level 3: Intraoperative eighth cranial nerve monitoring should be used during vestibular schwannoma surgery when hearing preservation is attempted.

COCHLEAR NERVE MONITORING

Question 5 Is direct monitoring of the eighth cranial nerve superior to the use of far-field auditory brain stem responses?

COCHLEAR NERVE MONITORING

Target Population This recommendation applies to adult patients undergoing vestibular schwannoma surgery with measurable preoperative hearing levels and tumors smaller than 1.5 cm.

COCHLEAR NERVE MONITORING

Recommendation Level 3: There is insufficient evidence to make a definitive recommendation.

COCHLEAR NERVE MONITORING

The full guideline can be found at: https://www.cns.org/guidelines/guidelines-manage-ment-patients-vestibular-schwannoma/chapter_4.

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