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Skull base surgery. 1995 October; 5(4): 245–250.
PMCID: PMC1656530

Technical Aspects of Intraoperative Monitoring of Lower Cranial Nerve Function


The efficacy of monitoring facial nerve activity in decreasing long-term morbidity has promoted an interest in monitoring other at-risk cranial nerves during procedures that involve manipulation of the basal cranial nerves. This presentation details practical techniques for monitoring the lower cranial nerves, which have been experientially developed over the past 9 years. Emphasis is placed on the selection of electrodes and procedural changes required for reliable and safe stimulation of the basal cranial nerves. Either paired hook-wire or tethered needle electrodes can be used for monitoring glossopharyageal, accessory, and hypoglossal nerve function. Several options for monitoring vagus nerve function are discussed. Of these, the transoral placement of paired hook-wire electrodes remains the most reliable, cost-effective, and least morbid technique. Electrical stimulation of the glossopharyngeal and vagus nerves carries the risk of unanticipated, potentially irreversible disturbances in cardiovascular function. Guidelines for type and optimal placement of stimulating electrodes and recommended intensity levels to prevent unfavorable reactions are presented.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Prass RL, Lüders H. Acoustic (loudspeaker) facial electromyographic monitoring: Part 1. Evoked electromyographic activity during acoustic neuroma resection. Neurosurgery. 1986 Sep;19(3):392–400. [PubMed]
  • Harner SG, Daube JR, Ebersold MJ, Beatty CW. Improved preservation of facial nerve function with use of electrical monitoring during removal of acoustic neuromas. Mayo Clin Proc. 1987 Feb;62(2):92–102. [PubMed]
  • Harner SG, Daube JR, Beatty CW, Ebersold MJ. Intraoperative monitoring of the facial nerve. Laryngoscope. 1988 Feb;98(2):209–212. [PubMed]
  • Schwaber MK, Netterville JL, Maciunas R. Microsurgical anatomy of the lower skullbase--a morphometric analysis. Am J Otol. 1990 Nov;11(6):401–405. [PubMed]
  • Leonetti JP, Mokarry VP, Fan Z, Warf P, Hudson E. Vagal Nerve Monitoring during Parapharyngeal Space Tumor Removal. Skull Base Surg. 1994;4(4):213–218. [PMC free article] [PubMed]

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