{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T22:50:44Z","timestamp":1783205444250,"version":"3.54.6"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"04","funder":[{"name":"Deutsche Forschungsgemeinschaft DFG","award":["PR1275\/1-2"],"award-info":[{"award-number":["PR1275\/1-2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg A Cent Eur Neurosurg"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003The quantity of A-trains, a high-frequency pattern of free-running facial nerve electromyography, is correlated with the risk for postoperative high-grade facial nerve paresis. This correlation has been confirmed by automated analysis with dedicated algorithms and by visual offline analysis but not by audiovisual real-time analysis.<\/jats:p><jats:p>\n          Methods\u2003An investigator was presented with 29 complete data sets measured during actual surgeries in real time and without breaks in a random order. Data were presented either strictly via loudspeaker (audio) or simultaneously by loudspeaker and computer screen (audiovisual). Visible and\/or audible A-train activity was then quantified by the investigator with the computerized equivalent of a stopwatch. The same data were also analyzed with quantification of A-trains by automated algorithms.<\/jats:p><jats:p>\n          Results\u2003Automated (auto) traintime (TT), known to be a small, yet highly representative fraction of overall A-train activity, ranged from 0.01 to 10.86\u2009s (median: 0.58\u2009s). In contrast, audio-TT ranged from 0 to 1,357.44\u2009s (median: 29.69\u2009s), and audiovisual-TT ranged from 0 to 786.57\u2009s (median: 46.19\u2009s). All three modalities were correlated to each other in a highly significant way. Likewise, all three modalities correlated significantly with the extent of postoperative facial paresis. As a rule of thumb, patients with visible\/audible A-train activity\u2009&lt;\u20091\u2009minute presented with a more favorable clinical outcome than patients with\u2009&gt;\u20091\u2009minute of A-train activity.<\/jats:p><jats:p>\n          Conclusion\u2003Detection and even quantification of A-trains is technically possible not only with intraoperative automated real-time calculation or postoperative visual offline analysis, but also with very basic monitoring equipment and real-time good quality audiovisual analysis. However, the investigator found audiovisual real-time-analysis to be very demanding; thus tools for automated quantification can be very helpful in this respect.<\/jats:p>","DOI":"10.1055\/s-0040-1701616","type":"journal-article","created":{"date-parts":[[2021,1,9]],"date-time":"2021-01-09T02:39:35Z","timestamp":1610159975000},"page":"308-316","source":"Crossref","is-referenced-by-count":7,"title":["Facial Nerve EMG: Low-Tech Monitoring with a Stopwatch"],"prefix":"10.1055","volume":"82","author":[{"given":"Julian","family":"Prell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Halle, Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Scheller","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Halle, Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Simmermacher","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Halle, Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Strauss","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Halle, Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Rampp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Halle, Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,1,8]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1177\/019459989010300502","article-title":"Intraoperative monitoring of facial nerve function in cerebellopontine angle surgery","volume":"103","author":"P E Hammerschlag","year":"1990","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/00004691-199805000-00004","article-title":"Facial nerve electromyography and other cranial nerve monitoring","volume":"15","author":"C M Harper","year":"1998","journal-title":"J Clin Neurophysiol"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3109\/02688699108998442","article-title":"The impact of continuous electrophysiological monitoring on preservation of the facial nerve during acoustic tumour surgery","volume":"5","author":"D A Jellinek","year":"1991","journal-title":"Br J Neurosurg"},{"issue":"10","key":"ref4","doi-asserted-by":"crossref","first-page":"501","DOI":"10.2176\/nmc.40.501","article-title":"Can continuous intraoperative facial electromyography predict facial nerve function following cerebellopontine angle surgery?","volume":"40","author":"T Kombos","year":"2000","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1177\/019459988709700605","article-title":"Acoustic (loudspeaker) facial EMG monitoring: II. 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Studies in Healthy and Diseased Muscle. 2nd ed","author":"E Stalberg","year":"1994"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/WNP.0b013e318257cabc","article-title":"How many electromyography channels do we need for facial nerve monitoring?","volume":"29","author":"S Rampp","year":"2012","journal-title":"J Clin Neurophysiol"},{"issue":"09","key":"ref14","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1016\/j.clinph.2014.11.028","article-title":"The intermedius nerve as a confounding variable for monitoring of the free-running electromyogram","volume":"126","author":"J Prell","year":"2015","journal-title":"Clin Neurophysiol"},{"issue":"07","key":"ref15","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1007\/s00701-012-1359-4","article-title":"The nervus intermedius as a variable landmark and critical structure in cerebellopontine angle surgery: an anatomical study and classification","volume":"154","author":"A Alfieri","year":"2012","journal-title":"Acta Neurochir (Wien)"},{"issue":"07","key":"ref16","doi-asserted-by":"crossref","first-page":"E144","DOI":"10.3174\/ajnr.A2624","article-title":"The functions of the nervus intermedius","volume":"32","author":"A Alfieri","year":"2011","journal-title":"AJNR Am J Neuroradiol"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s00701-013-1952-1","article-title":"The relationship between nervus intermedius anatomy, ultrastructure, electrophysiology, and clinical function. 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