Technology of intraoperative neuromonitoring by the method of polyprogram electric stimulation at reconstructive neuroplasty operations

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Abstract

Introduction. When operating on the face and neck, a technology for intraoperatuve neurophysiological monitoring is used to ensure the right nerve function.

Aim. Development of a technology for the intraoperatuve neuromonitoring and a practical estimation of its efficiency in the reconstructive neuroplasty surgery.

Methods. In 120 patients with the paralysis of mimic muscles after the removal of a cerebellopontine angle neuroma and a facial nerve damage, neuroplasty was performed to restore the innervation. An original technique was developed for identification and monitoring of the functional state of the nerves and muscles — intraoperative visual neuromonitoring (IOVNM). Its concept consists in electric stimulation of the nerves within the surgical field and visual observation of the response muscular contractions. A special ESVM-1 electric stimulator with a set of built-in test programs has been created. The control of the instrument, selection of tests, their launch, visual observation of the reactions and the intraoperative monitoring itself are performed by the operating surgeon.

Results. The presented technology eliminates the need for a complex equipment for neurophysiological monitoring and does not require the participation of a specialist in neurophysiology.

Conclusion. The use of IOVNM during the operation provides an opportunity to assess the functional state of the facial nerve and mimic muscles, to optimize the operation scheme and accelerate its implementation.

About the authors

Marina M. Somova

Central Scientific Institute of Stomatology and Maxillo-Facial Surgery

Author for correspondence.
Email: domanski@ntcup.ru
ORCID iD: 0000-0002-4221-0677

младший научный сотрудник

Russian Federation, Moscow

Valery L. Domanskiy

Scientific and Technological Centre of Unique Instruments of Russian Academy of Sciences

Email: domanski@ntcup.ru
ORCID iD: 0000-0002-3931-1418
SPIN-code: 7948-5484

PHD

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Electrical stimulator ESVM-1 for intraoperative visual neuromonitoring

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3. Fig. 2. Electrical stimulator ESVM-1. The shape and parameters of the output pulses

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4. Fig. 3. The general scheme of the operation of peripheral neuroplasty VII – XII – VII pairs of cranial nerves “end to side”

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5. Fig. 4. The formation of the end-to-side anastomosis with the hyoid nerve

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6. Fig. 5. The formation of the anastomosis "end to side" with the facial nerve

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7. Fig. 6. The formation of the end-to-end anastomosis of the chewing nerve with the facial

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8. Fig. 7. The formation of the anastomosis "side to side" of the hyoid nerve with the facial

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9. Fig. 8. The formation of the end-to-side anastomosis of the chewing nerve with the facial

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Copyright (c) 2020 Somova M.M., Domanskiy V.L.

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