Download PDF
J Neurol Surg B Skull Base 2017; 78(01): 043-051
DOI: 10.1055/s-0036-1584557
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Brainstem Auditory Evoked Potentials' Diagnostic Accuracy for Hearing Loss: Systematic Review and Meta-Analysis

Parthasarathy D. Thirumala
1   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
2   Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Gregory Carnovale
3   Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
Yoon Loke
4   Norwich Medical School, University of East Anglia, Norwich, United Kingdom
,
Miguel E. Habeych
1   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Donald J. Crammond
1   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Jeffrey R. Balzer
1   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
3   Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
,
Raymond F. Sekula
1   Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

22 December 2015

03 February 2016

Publication Date:
20 June 2016 (online)

    Permissions and Reprints

Abstract

Background Microvascular decompression (MVD) utilizes brainstem auditory evoked potential (BAEP) intraoperative monitoring to reduce the risk of iatrogenic hearing loss. Studies report varying efficacy and hearing loss rates during MVD with intraoperative monitoring.

Objectives This study aims to perform a comprehensive review and study of diagnostic accuracy of BAEPs during MVD to predict hearing loss in studies published from January 1984 to December 2013.

Methods The PubMed/MEDLINE and World Science databases were searched. Studies performed MVD for trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia or geniculate neuralgia and monitored intraoperative BAEPs to prevent hearing loss. Retrospectively, BAEP parameters were compared with postoperative hearing. The diagnostic accuracy of significant change in BAEPs, which includes loss of response, was tested using summary receiver operative curve and diagnostic odds ratio (DOR).

Results A total of 13 studies were included in the analysis with a total of 2,540 cases. Loss of response pooled sensitivity, specificity, and DOR with 95% confidence interval being 74% (60–84%), 98% (88–100%), and 69.3 (18.2–263%), respectively. The similar significant change results were 88% (77–94%), 63% (40–81%), and 9.1 (3.9–21.6%).

Conclusion Patients with hearing loss after MVD are more likely to have shown loss of BAEP responses intraoperatively. Loss of responses has high specificity in evaluating hearing loss. Patients undergoing MVD should have BAEP monitoring to prevent hearing loss.

Keywords

evoked potentials - auditory - brainstem - hemifacial spasm - trigeminal neuralgia - glossopharyngeal nerve diseases - hearing loss
 

  • References

  • 1 Acevedo JC, Sindou M, Fischer C, Vial C. Microvascular decompression for the treatment of hemifacial spasm. Retrospective study of a consecutive series of 75 operated patients—electrophysiologic and anatomical surgical analysis. Stereotact Funct Neurosurg 1997; 68 (1-4 Pt 1): 260-265
    CrossrefPubMedGoogle Scholar
  • 2 Patel A, Kassam A, Horowitz M, Chang YF. Microvascular decompression in the management of glossopharyngeal neuralgia: analysis of 217 cases. Neurosurgery 2002; 50 (4) 705-710 , discussion 710–711
    CrossrefPubMedGoogle Scholar
  • 3 Ramnarayan R, Mackenzie I. Brain-stem auditory evoked responses during microvascular decompression for trigeminal neuralgia: predicting post-operative hearing loss. Neurol India 2006; 54 (3) 250-254
    CrossrefPubMedGoogle Scholar
  • 4 Little JR, Lesser RP, Lueders H, Furlan AJ. Brain stem auditory evoked potentials in posterior circulation surgery. Neurosurgery 1983; 12 (5) 496-502
    CrossrefPubMedGoogle Scholar
  • 5 Rizvi SS, Goyal RN, Calder HB. Hearing preservation in microvascular decompression for trigeminal neuralgia. Laryngoscope 1999; 109 (4) 591-594
    CrossrefPubMedGoogle Scholar
  • 6 Shah A, Nikonow T, Thirumala P , et al. Hearing outcomes following microvascular decompression for hemifacial spasm. Clin Neurol Neurosurg 2012; 114 (6) 673-677
    CrossrefPubMedGoogle Scholar
  • 7 Rupa V, Saunders RL, Weider DJ. Geniculate neuralgia: the surgical management of primary otalgia. J Neurosurg 1991; 75 (4) 505-511
    CrossrefPubMedGoogle Scholar
  • 8 Wilkins RH, Radtke RA, Erwin CW. Value of intraoperative brainstem auditory evoked potential monitoring in reducing the auditory morbidity associated with microvascular decompression of cranial nerves. Skull Base Surg 1991; 1 (2) 106-109
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Martin WH, Stecker MM. ASNM position statement: intraoperative monitoring of auditory evoked potentials. J Clin Monit Comput 2008; 22 (1) 75-85
    CrossrefPubMedGoogle Scholar
  • 10 American Electroencephalographic Society. Guideline eleven: guidelines for intraoperative monitoring of sensory evoked potentials. J Clin Neurophysiol 1994; 11 (1) 77-87
    CrossrefPubMedGoogle Scholar
  • 11 Simunovic N, Sprague S, Bhandari M. Methodological issues in systematic reviews and meta-analyses of observational studies in orthopaedic research. J Bone Joint Surg Am 2009; 91 (Suppl. 03) 87-94
    PubMedGoogle Scholar
  • 12 Thirumala PD, Carnovale G, Habeych ME, Crammond DJ, Balzer JR. Diagnostic accuracy of brainstem auditory evoked potentials during microvascular decompression. Neurology 2014; 83 (19) 1747-1752
    CrossrefPubMedGoogle Scholar
  • 13 Whiting PF, Rutjes AW, Westwood ME , et al; QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155 (8) 529-536
    CrossrefPubMedGoogle Scholar
  • 14 Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005; 58 (10) 982-990
    CrossrefPubMedGoogle Scholar
  • 15 Sindou M, Fobé JL, Ciriano D, Fischer C. Hearing prognosis and intraoperative guidance of brainstem auditory evoked potential in microvascular decompression. Laryngoscope 1992; 102 (6) 678-682
    CrossrefPubMedGoogle Scholar
  • 16 James ML, Husain AM. Brainstem auditory evoked potential monitoring: when is change in wave V significant?. Neurology 2005; 65 (10) 1551-1555
    CrossrefPubMedGoogle Scholar
  • 17 Brock S, Scaioli V, Ferroli P, Broggi G. Neurovascular decompression in trigeminal neuralgia: role of intraoperative neurophysiological monitoring in the learning period. Stereotact Funct Neurosurg 2004; 82 (5–6): 199-206
    CrossrefPubMedGoogle Scholar
  • 18 Huang BR, Chang CN, Hsu JC. Intraoperative electrophysiological monitoring in microvascular decompression for hemifacial spasm. J Clin Neurosci 2009; 16 (2) 209-213
    CrossrefPubMedGoogle Scholar
  • 19 Jo KWL, Lee JA, Park K, Cho YS. A new possible mechanism of hearing loss after microvascular decompression for hemifacial spasm. Otol Neurotol 2013; 34 (7) 1247-1252
    CrossrefPubMedGoogle Scholar
  • 20 Lee SH, Song DG, Kim S, Lee JH, Kang DG. Results of auditory brainstem response monitoring of microvascular decompression: a prospective study of 22 patients with hemifacial spasm. Laryngoscope 2009; 119 (10) 1887-1892
    CrossrefPubMedGoogle Scholar
  • 21 Bond AE, Zada G, Gonzalez AA, Hansen C, Giannotta SL. Operative strategies for minimizing hearing loss and other major complications associated with microvascular decompression for trigeminal neuralgia. World Neurosurg 2010; 74 (1) 172-177
    CrossrefPubMedGoogle Scholar
  • 22 Li J, Shi R. Stretch-induced nerve conduction deficits in guinea pig ex vivo nerve. J Biomech 2007; 40 (3) 569-578
    CrossrefPubMedGoogle Scholar
  • 23 Ogata K, Naito M. Blood flow of peripheral nerve effects of dissection, stretching and compression. J Hand Surg [Br] 1986; 11 (1) 10-14
    CrossrefPubMedGoogle Scholar
  • 24 Wall EJ, Massie JB, Kwan MK, Rydevik BL, Myers RR, Garfin SR. Experimental stretch neuropathy. Changes in nerve conduction under tension. J Bone Joint Surg Br 1992; 74 (1) 126-129
    PubMedGoogle Scholar
  • 25 Baik MW, Branston NM, Bentivoglio P, Symon L. The effects of experimental brain-stem ischaemia on brain-stem auditory evoked potentials in primates. Electroencephalogr Clin Neurophysiol 1990; 75 (5) 433-443
    CrossrefPubMedGoogle Scholar
  • 26 Lin CD, Wei IH, Tsai MH , et al. Changes in guinea pig cochlea after transient cochlear ischemia. Neuroreport 2010; 21 (15) 968-975
    PubMedGoogle Scholar
  • 27 Harner SG, Harper CM, Beatty CW, Litchy WJ, Ebersold MJ. Far-field auditory brainstem response in neurotologic surgery. Am J Otol 1996; 17 (1) 150-153
    PubMedGoogle Scholar
  • 28 Nadol Jr JB, Chiong CM, Ojemann RG , et al. Preservation of hearing and facial nerve function in resection of acoustic neuroma. Laryngoscope 1992; 102 (10) 1153-1158
    CrossrefPubMedGoogle Scholar