Mehmet AKDAĞ, Ediz Argün YORGANCILAR, Müzeyyen YILDIRIM BAYLAN

Koklear İmplant ve Fasiyal Tümör Cerrahisinde Fasiyal Stimilatör Kullanımı

Amaç: Bu klinik proje çalışmamızdaki amacımız; otolojik ve nörotolojik cerrahide fasiyal sinir monitörizasyonunun cerrahi güvenliğini ve operasyonun süresine etkilerini araştırmaktı. Yöntemler: Olgularımızdan toplam171 hastadan 141 hastaya stimulasyon probu kullanılarak moniterize edildi. İstatistik çalışma sadece otolojik hastalarda yapıldı. Otolojik cerrahiden geri kalan 30 hastaya hiç moniterize edilmedi. Bu hastalardan moniterize edilmeyen otolojik 30 hasta ile moniterize edilen ve rastgele seçilen 30 otolojik hasta seçilerek cerrahi süre ve komplikasyon karşılaştırılması yapıldı. Bulgular: Olgularımızda 7 vakada stimilasyon’a rağmen cevap alamama; 2 hastada ise stimilasyon şiddeti artırılarak cevap alınırken diğer tüm 162 hastada cevap alındı. Cevap alınamayan 7 hastada 3 hastada elektrot temassızlığı; 2 hastada sinir yorgunluğu, bir hastada ise anestezi de kullanılan kas gevşeticilerin kullanımı söz konusu iken bir hastada da sebep bulunamadı. Yine bir hastada uyarı alınmasına karşın postoperatif geçici parezi saptandı. Zamansal olarak monitör takılmayan koklear implant hastalarda cerrahi ortalama süresi 2.35 saat sürerken moniterize edilen hastalarda ise bu süre ise 1.45 saat sürdü. Komplikasyon açısından anlamlı fark bulunamadı. Sonuç: Bu teknolojiyi kullanmanın tüm cerrahlar için, gerek elektrofizyolojik veri ve gerekse cerrahi güven ve komplikasyonları azaltma konusunda önemli ve anlamlı destek sağlayabileceğini düşünmekteyiz.

The Use Of Fasial Stımilator in Cochlear implant and Fasial Tumor Surgery

Objective: Our aim in conducting this clinical study that project was to investigate the surgical safety of facial nervemonitoring along with its effects on the duration of the operation in otologic and neurotologic surgery.Methods: We have used intraoperative monitoring and stimulation of facial nerve function routinely in 161 cochlearsurgery, and 10 neurotologic cases. Statistical study was performed only in otologic patients. The 171 patients whounderwent surgery, of the remaning 30 otologic surgery cases were randomly selected that were monitered. Theremaining 30 otologic surgery cases were not monitored and compared statistically for the duration of the operationand the emerging complications.Results: Of the study patients; no responses were detected in seven despite the stimulation. Response occurred onlyafter increasing the amplitude of the stimulation current in two patients. In the remaining 162 patients, the responseswere detected. Of the seven patients, in whom no responses were detected; electrode contact was lost in three, nervefatigue was found in two, and muscle-relaxant use for anesthesia was detected in one patient; while, no causes wereidentified in one patient. Despite the presence of responses, a transient postoperative paresis was observed in onepatient. In cochlear implant patients, the mean duration of surgery was 2.35 hours without monitoring; whereas, itwas 1.45 hours in monitored patients.Conclusion: We are of the opinion that this technological method may contribute significantly to obtainingelectrophysiologic data, as well as ensuring the safety of the operation and reducing the complication rates.

PDF

___

1. Green JD, Shelton C, Brackmann DE. Iatrogenic facial nerve injury during otologic surgery. Laryngoscope. 1994; 104: 922-6.
2. Marina MB, Mazita A, Fadzilah I, et al. Iatrogenic facial nerve palsy: lessons to learn. Singapore Med J. 2009; 50: 1154-7.
3. Silverstein H. Adaptor for continuos Stimulation (SACS) with the WR-S8 monitor stimulator. Otolaryngol Head Neck Surg. 1990; 103: 493-6.
4. Schuring AG. Iatrogenic facial nerve injury. Am J Otol. 1988; 9: 432-3.
5. Nilssen EL, Wormald PJ. Facial nerve palsy in mastoid surgery. J Laryngol Otol. 1997; 111: 113-6.
6. Selesnick SH, Lynn-Macrae AG. The incidence of facial nerve dehiscence at surgery for cholesteatoma. Otol Neurotol. 2001; 22: 129-32.
7. Wang H-M, Lin J-C, Lee K-W, et al. Analysis of mastoid findings at surgery to treat middle ear cholesteatoma. Arch Otolaryngol Head Neck Surg. 2006; 132: 1307-10.
8. Delgado TE, Bucheit WA, Rosenholtz HR, et al. Intraoperative monitoring of facila muscle evoked responses obtained by intracranial stimulation of the facila nerve: a more accurate technique for facila nerve dissection. Neurosurgery. 1979; 4: 418-21.
9. Roland PS, Meyerhoff WL. Intraoperative electrophysiological monitoring of the facial nerve: Is it standard of practice? Am J Otolaryngol. 1994; 15: 267- 70.
10. Prass RL. Iatrogenic facial nerve injury: the role of facial nerve monitoring. Otolaryngol Clin North Am. 1996; 29: 265-75.
11. Dr. Nuri Özgirgin, Dr. Tuncay Özçelik, Dr. Selçuk Aksoy, Dr. Barkın Gürcan. Fasiyal sinir monitorizasyonu. K.B.B. ve Baş Boyun Cerrahisi Dergisi.1993; l: 205-8.
12. Silverstein H., Smouha EE., Jones R. Routine intraoperative facial nerve monitoring during otologic surgery. The American Journal of Otology.1988; 9: 269- 75.
13. Leonetti JP, Matz GJ, Smith PG. Facial nerve monitoring in otologic surgery: clinical indications and intraoperative technique. Ann Otol Rhinol Laryngol. 1990; 99: 911-8.
14. Guntinas-Lichius O, Eisele DW. Facial Nerve Monitoring. Adv Otorhinolaryngol. 2016; 78: 46-52.
15. Babin RW, Ryu JH, McCabe BF. Responses to step and repeated impulse accelerations in second order vestibular neurons of the cat. Am J Otolaryngol. 1980; 1: 385-923.
16. Boublata L, Belahreche M, Ouchtati R, et al. Int Vestibular Schwannomas Surgery Operated By Retrosigmoid Transmeatal Approach in Semi-sitting Position with Intraoperative Facial Nerve Monitoring. World Neurosurg. 2017; 103: 231-40.
17. Yingling CD, Gardi JN. Intraoperative monitoring of facial and cochlear nerves during acoustic neuroma surgery. 1992. Neurosurg Clin N Am. 2008; 19: 289- 315.
18. Chen L, Chen L, Liu L, et al. Vestibular schwannoma microsurgery with special reference to facial nerve preservation. Clin Neurol Neurosurg. 2009; 111: 47-53.
19. Yingling CD, Gardi JN. Intraoperative monitoring of facial and cochlear nerves during acoustic neuroma surgery. 1992. Neurosurg Clin N Am. 2008; 19: 289- 315.
20. Kassam S Chegini S,M Kumar. Pitfalls in monitoring of the facial nerve during operations for parotid cancer. British Journal of Oral and Maxillofacial Surgery.2017; 55: 863–4.