{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:05:37Z","timestamp":1791288337044,"version":"4.3.0"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2000,10]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic> Electromyography (EMG) monitoring is expected to reduce the incidence of motor cranial nerve deficits in cerebellopontine angle surgery. The aim of this study was to provide a detailed analysis of intraoperative EMG phenomena with respect to their surgical significance.<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic> Using a system that continuously records facial and lower cranial nerve EMG signals during the entire operative procedure, the authors examined 30 patients undergoing surgery on acoustic neuroma (24 patients) or meningioma (six patients). Free-running EMG signals were recorded from muscles targeted by the facial, trigeminal, and lower cranial nerves, and were analyzed off-line with respect to waveform characteristics, frequencies, and amplitudes. Intraoperative measurements were correlated with typical surgical maneuvers and postoperative outcomes.<\/jats:p><jats:p content-type=\"fine-print\">Characteristic EMG discharges were obtained: spikes and bursts were recorded immediately following the direct manipulation of a dissecting instrument near the cranial nerve, but also during periods when the nerve had not yet been exposed. Bursts could be precisely attributed to contact activity. Three distinct types of trains were identified: A, B, and C trains. Whereas B and C trains are irrelevant with respect to postoperative outcome, the A train\u2014a sinusoidal, symmetrical sequence of high-frequency and low-amplitude signals\u2014was observed in 19 patients and could be well correlated with additional postoperative facial nerve paresis (in 18 patients).<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic> It could be demonstrated that the occurrence of A trains is a highly reliable predictor for postoperative facial palsy. Although some degree of functional worsening is to be expected postoperatively, there is a good chance of avoiding major deficits by warning the surgeon early. Continuous EMG monitoring is superior to electrical nerve stimulation or acoustic loudspeaker monitoring alone. The detailed analysis of EMG-waveform characteristics is able to provide more accurate warning criteria during surgery.<\/jats:p>","DOI":"10.3171\/jns.2000.93.4.0586","type":"journal-article","created":{"date-parts":[[2009,5,13]],"date-time":"2009-05-13T17:27:53Z","timestamp":1242235673000},"page":"586-593","source":"Crossref","is-referenced-by-count":240,"title":["Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery"],"prefix":"10.3171","volume":"93","author":[{"given":"Johann","family":"Romst\u00f6ck","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Strauss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf","family":"Fahlbusch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Laryngoscope","first-page":"1318","article-title":"Intraoperative BAER monitoring and hearing preservation in the treatment of acoustic neuromas.","volume":"95","author":"Abramson","year":"1985"},{"key":"b2","series-title":"NIH Consens Statement","first-page":"1","article-title":"NIH Consensus Development Conference: acoustic neuroma.","volume":"9","year":"1991"},{"key":"b3","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1227\/00006123-197905000-00007","article-title":"Intraoperative monitoring of facial muscle evoked responses obtained by intracranial stimulation of the facial nerve: a more accurate technique for facial nerve dissection.","volume":"4","author":"Delgado","year":"1979"},{"key":"b4","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1227\/00006123-199508000-00010","article-title":"The mapping and continuous monitoring of the intrinsic motor nuclei during brainstem surgery.","volume":"37","author":"Eisner","year":"1995"},{"key":"b5","series-title":"Acta Neurochir","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1007\/s007010050178","article-title":"Preservation of hearing in large acoustic neurinomas following removal via suboccipito-lateral approach.","volume":"140","author":"Fahlbusch","year":"1998"},{"key":"b6","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"910","DOI":"10.3171\/jns.1992.76.6.0910","article-title":"Hearing preservation in acoustic neurinoma surgery.","volume":"76","author":"Fischer","year":"1992"},{"key":"b7","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1177\/019459989010300502","article-title":"Intraoperative monitoring of facial nerve function in cerebellopontine angle surgery.","volume":"103","author":"Hammerschlag","year":"1990"},{"key":"b8","series-title":"Laryngoscope","first-page":"209","article-title":"Intraoperative monitoring of the facial nerve.","volume":"98","author":"Harner","year":"1988"},{"key":"b9","series-title":"Laryngoscope","first-page":"65","article-title":"Electrophysiologic monitoring of facial nerve during temporal bone surgery.","volume":"96","author":"Harner","year":"1986"},{"key":"b10","series-title":"Mayo Clin Proc","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/S0025-6196(12)61876-X","article-title":"Improved preservation of facial nerve function with use of electrical monitoring during removal of acoustic neuromas.","volume":"62","author":"Harner","year":"1987"},{"key":"b11","series-title":"J Clin Neurophysiol","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1097\/00004691-199805000-00004","article-title":"Facial nerve electromyography and other cranial nerve monitoring.","volume":"15","author":"Harper","year":"1998"},{"key":"b12","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1177\/019459988509300202","article-title":"Facial nerve grading system.","volume":"93","author":"House","year":"1985"},{"key":"b13","series-title":"Practical Electromyography","year":"1997"},{"key":"b14","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1177\/019459988910100416","article-title":"Electroneurography and intraoperative facial monitoring in contemporary neurotology.","volume":"101","author":"Kartush","year":"1989"},{"key":"b15","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1080\/01616412.1998.11740569","article-title":"Intra-operative monitoring in acoustic neuroma surgery.","volume":"20","author":"Kartush","year":"1998"},{"key":"b16","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1177\/019459989110400117","article-title":"Operative management of acoustic neuromas: the priority of neurologic function over complete resection.","volume":"104","author":"Kemink","year":"1991"},{"key":"b17","series-title":"Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice.","author":"Kimura","year":"1983"},{"key":"b18","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1177\/019459989411100505","article-title":"Facial nerve outcome after acoustic neuroma surgery: a study from the era of cranial nerve monitoring.","volume":"111","author":"Lalwani","year":"1994"},{"key":"b19","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3109\/02688699009000675","article-title":"Factors influencing the preservation of the facial nerve during acoustic surgery.","volume":"4","author":"Lee","year":"1990"},{"key":"b20","series-title":"Ann Otol Rhinol Laryngol","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1177\/000348948409300203","article-title":"Monitoring auditory evoked potentials during acoustic neuroma surgery. Insights into the mechanism of the hearing loss.","volume":"93","author":"Levine","year":"1984"},{"key":"b21","series-title":"Neurosurgery","first-page":"459","article-title":"Management of vestibular schwannomas (acoustic neuromas): the value of neurophysiology for intraoperative monitoring of auditory function in 200 cases.","volume":"40","author":"Matthies","year":"1997"},{"key":"b22","series-title":"Clin Neurosurg","first-page":"171","article-title":"Intra-operative neurophysiologic monitoring in neurosurgery: benefits, efficacy, and cost-effectiveness.","volume":"42","author":"M\u00f8ller","year":"1995"},{"key":"b23","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"757","DOI":"10.3171\/jns.1984.61.4.0757","article-title":"Preservation of facial function during removal of acoustic neuromas. Use of monopolar constant-voltage stimulation and EMG.","volume":"61","author":"M\u00f8ller","year":"1984"},{"key":"b24","series-title":"Clin Neurophysiol","doi-asserted-by":"publisher","first-page":"1935","DOI":"10.1016\/S1388-2457(99)00148-0","article-title":"The prognostic value of intraoperative BAEP patterns in acoustic neurinoma surgery.","volume":"110","author":"Neu","year":"1999"},{"key":"b25","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1177\/019459988709700605","article-title":"Acoustic (loudspeaker) facial EMG monitoring: II. Use of evoked EMG activity during acoustic neuroma resection.","volume":"97","author":"Prass","year":"1987"},{"key":"b26","series-title":"Neurosurgery","first-page":"392","article-title":"Acoustic (loudspeaker) facial electromyographic monitoring: Part 1. Evoked electromyographic activity during acoustic neuroma resection.","volume":"19","author":"Prass","year":"1986"},{"key":"b27","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"341","DOI":"10.3171\/jns.1982.57.3.0341","article-title":"Intraoperative monitoring of brainstem auditory evoked potentials.","volume":"57","author":"Raudzens","year":"1982"},{"key":"b28","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1097\/00006123-199704000-00006","article-title":"Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve\u2014preservation and restitution of function.","volume":"40","author":"Samii","year":"1997"},{"key":"b29","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1177\/019459989411000202","article-title":"Preservation of facial, cochlear, and other nerve functions in acoustic neuroma treatment.","volume":"110","author":"Sterkers","year":"1994"},{"key":"b30","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"747","DOI":"10.3171\/jns.1982.57.6.0747","article-title":"Technical and instrumental improvements in the surgical treatment of acoustic neurinomas.","volume":"57","author":"Sugita","year":"1982"},{"key":"b31","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"655","DOI":"10.3109\/02688699409101179","article-title":"Facial and acoustic nerve preservation during excision of extracanalicular acoustic neuromas using the suboccipital approach.","volume":"8","author":"Torrens","year":"1994"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/93\/4\/article-p586.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/93\/4\/article-p586.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/93\/4\/article-p586.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T22:32:30Z","timestamp":1679869950000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/93\/4\/article-p586.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,10]]},"references-count":31,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/jns.2000.93.4.0586","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[2000,10]]}}}