The predictive value of intraoperative facial motor evoked potentials in cerebellopontine angle tumor surgery

• Published in: Clinical neurophysiology 2024-10, Vol.166, p.176-190
• Main Authors: Pan, Szu-Yen, Holdefer, Robert N., Wu, Han-Lin, Li, Chi-Ruei, Guo, Lanjun
• Format: Article
• Language: English
• Subjects: Cerebellar Neoplasms - physiopathology; Cerebellar Neoplasms - surgery; Cerebellopontine Angle - physiopathology; Cerebellopontine Angle - surgery; Cerebellopontine angle tumor (CPA tumor); Corticobulbar tract motor evoked potential (Corticobulbar MEP or CoMEP); Evoked Potentials, Motor - physiology; Facial motor evoked potentials (FMEP); Facial Nerve - physiopathology; Humans; Intraoperative Neurophysiological Monitoring - methods; Predictive Value of Tests; Skull base surgery
• ISSN: 1388-2457; 1872-8952; 1872-8952
• DOI: 10.1016/j.clinph.2024.07.021

•First meta-analysis characterized diagnostic accuracy of facial motor evoked potentials for cerebellopontine angle tumor surgeries.•Facial motor evoked potentials were a useful indicator for postoperative facial outcomes in both immediate and follow-up periods.•Amplitude cutoff criteria and a dichotomous facial strength assessment improved facial motor evoked potentials accuracy. Our aim is to explore the value of intraoperative facial motor evoked potentials (FMEP) for facial outcomes in cerebellopontine angle (CPA) tumor surgery to provide an evidence-based consensus standard for future clinical practice and prospective studies. Electronic databases were searched from inception to June 2023. Study quality was assessed with the QUADAS-2 tool. Bivariate and random-effects models for meta-analysis and meta-regression generated summary receiver operating characteristic curves (ROC) and forest plots for estimates of sensitivity and specificity. We included 17 studies (1,206 participants). Sensitivity was lower in the immediate (IM) post-operative (0.76, 95% CI 0.65–0.84) compared to follow-up (FU) period (0.82, 95% CI 0.74–0.88) while specificity was similar in both groups (IM, 0.94, 95% CI 0.89–0.97; FU, 0.93, 95% CI 0.87–0.96). Data driven estimates improved FMEP performance but require confirmation from future studies. Amplitude cutoff criteria and studies that scored new deficits as worse than House-Brackmann (HB) grade 2 yielded best sensitivities. FMEP demonstrated statistically significant accuracy for facial function monitoring. Implementation of FMEPs varied widely across studies. Our study is the first systematic review with meta-analysis to demonstrate that intraoperative FMEP is valuable in CPA tumor surgery for facial outcomes. Meta-regression identified the methods that were most useful in the application of FMEPs.