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Multimodal intraoperative monitoring of facial nerve function: combined use of blink reflex and corticobulbar motor evoked potentials.

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Τίτλος: Multimodal intraoperative monitoring of facial nerve function: combined use of blink reflex and corticobulbar motor evoked potentials.
Συγγραφείς: Fernández-Conejero I; Unit of Intraoperative Neurophysiology: Department of Neurology, Bellvitge University Hospital, ĹHospitalet de Llobregat, Barcelona 08907, Spain. Electronic address: isabelfernandez@bellvitgehospital.cat., Miró Lladó J; Unit of Intraoperative Neurophysiology: Department of Neurology, Bellvitge University Hospital, ĹHospitalet de Llobregat, Barcelona 08907, Spain., Alaniz Foyo O; Department of Anesthesiology, Bellvitge University Hospital, Spain., Contreras López L; Department of Anesthesiology, Bellvitge University Hospital, Spain., Sanmillán Blasco JL; Department of Neurosurgery, Bellvitge University Hospital, Spain., Torres Díaz A; Department of Neurosurgery, Bellvitge University Hospital, Spain.
Πηγή: Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology [Clin Neurophysiol] 2026 Oct; Vol. 190, pp. 2112335. Date of Electronic Publication: 2026 Jul 04.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 100883319 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-8952 (Electronic) Linking ISSN: 13882457 NLM ISO Abbreviation: Clin Neurophysiol Subsets: MEDLINE
Imprint Name(s): Original Publication: Amsterdam : Elsevier, c1999-
Ιατρικοί όροι (MeSH): Blinking*/physiology , Evoked Potentials, Motor*/physiology , Facial Nerve*/physiology , Facial Nerve*/physiopathology , Intraoperative Neurophysiological Monitoring*/methods, Facial Paralysis/physiopathology ; Humans ; Female ; Male ; Adult ; Middle Aged ; Aged ; Young Adult
Περίληψη: Objective: To compare the intraoperative blink reflex (BR) and facial corticobulbar motor evoked potentials (FCoMEPs) in skull base surgery, and to assess their respective and combined value in predicting postoperative facial nerve outcome.
Methods: 80 consecutive patients undergoing skull base surgery were monitored using ipsilateral FCoMEPs and bilateral BR recordings. BR was particularly assessed during stages in which FCoMEPs were limited by stimulus-induced movement. Facial nerve function was evaluated in the immediate postoperative period and at 6 months using the House-Brackmann (HB) scale. Cluster analysis was performed to identify patterns of intraoperative neurophysiological changes and their association with postoperative facial nerve outcome.
Results: Monitorability was 98.6% for the BR and 100% for FCoMEPs. 28 patients developed postoperative facial palsy, severe (HB V-VI) in eight cases. Seven of these patients showed significant intraoperative changes in both BR and FCoMEPs, whereas one showed no changes and recovered within days. All patients with mild to moderate dysfunction (HB II-III) recovered during follow-up. No patient with preserved BR at the end of surgery developed long-term facial nerve paresis. A reduction greater than 50% in BR and FCoMEP amplitudes was associated with poor facial nerve outcome (HB IV-VI).
Conclusions: Preserved BR and FCoMEPs are associated with favorable postoperative facial nerve outcome, whereas intraoperative loss of both modalities predict moderate to severe and potentially permanent facial nerve dysfunction. Preservation of BR at the end of surgery reliably indicates intact or only transient facial nerve impairment.
Significance: We describe novel features of BR that underscore its importance as a complement to FCoMEPs in skull base surgery.
(Copyright © 2026. Published by Elsevier B.V.)
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Contributed Indexing: Keywords: Blink reflex; Facial corticobulbar motor evoked potentials; Skull base surgery; Transcranial electrical stimulation
Entry Date(s): Date Created: 20260706 Date Completed: 20260812 Latest Revision: 20260812
Update Code: 20260813
DOI: 10.1016/j.clinph.2026.2112335
PMID: 42407405
Βάση Δεδομένων: MEDLINE
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  Data: Multimodal intraoperative monitoring of facial nerve function: combined use of blink reflex and corticobulbar motor evoked potentials.
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  Data: <searchLink fieldCode="AU" term="%22Fernández-Conejero+I%22">Fernández-Conejero I</searchLink>; Unit of Intraoperative Neurophysiology: Department of Neurology, Bellvitge University Hospital, ĹHospitalet de Llobregat, Barcelona 08907, Spain. Electronic address: isabelfernandez@bellvitgehospital.cat.<br /><searchLink fieldCode="AU" term="%22Miró+Lladó+J%22">Miró Lladó J</searchLink>; Unit of Intraoperative Neurophysiology: Department of Neurology, Bellvitge University Hospital, ĹHospitalet de Llobregat, Barcelona 08907, Spain.<br /><searchLink fieldCode="AU" term="%22Alaniz+Foyo+O%22">Alaniz Foyo O</searchLink>; Department of Anesthesiology, Bellvitge University Hospital, Spain.<br /><searchLink fieldCode="AU" term="%22Contreras+López+L%22">Contreras López L</searchLink>; Department of Anesthesiology, Bellvitge University Hospital, Spain.<br /><searchLink fieldCode="AU" term="%22Sanmillán+Blasco+JL%22">Sanmillán Blasco JL</searchLink>; Department of Neurosurgery, Bellvitge University Hospital, Spain.<br /><searchLink fieldCode="AU" term="%22Torres+Díaz+A%22">Torres Díaz A</searchLink>; Department of Neurosurgery, Bellvitge University Hospital, Spain.
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  Data: <searchLink fieldCode="JN" term="%22100883319%22">Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology</searchLink> [Clin Neurophysiol] 2026 Oct; Vol. 190, pp. 2112335. <i>Date of Electronic Publication: </i>2026 Jul 04.
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Elsevier%22">Elsevier </searchLink><i>Country of Publication: </i>Netherlands <i>NLM ID: </i>100883319 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1872-8952 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2213882457%22">13882457 </searchLink><i>NLM ISO Abbreviation: </i>Clin Neurophysiol <i>Subsets: </i>MEDLINE
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  Data: <i>Original Publication</i>: Amsterdam : Elsevier, c1999-
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  Data: <searchLink fieldCode="MM" term="%22Blinking%22">Blinking*</searchLink>/<searchLink fieldCode="MM" term="%22Blinking+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Evoked+Potentials%2C+Motor%22">Evoked Potentials, Motor*</searchLink>/<searchLink fieldCode="MM" term="%22Evoked+Potentials%2C+Motor+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Facial+Nerve%22">Facial Nerve*</searchLink>/<searchLink fieldCode="MM" term="%22Facial+Nerve+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Facial+Nerve%22">Facial Nerve*</searchLink>/<searchLink fieldCode="MM" term="%22Facial+Nerve+physiopathology%22">physiopathology</searchLink> <br /><searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring%22">Intraoperative Neurophysiological Monitoring*</searchLink>/<searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring+methods%22">methods</searchLink><br /><searchLink fieldCode="MH" term="%22Facial+Paralysis%22">Facial Paralysis</searchLink>/<searchLink fieldCode="MH" term="%22Facial+Paralysis+physiopathology%22">physiopathology</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%22">Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Young+Adult%22">Young Adult</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: To compare the intraoperative blink reflex (BR) and facial corticobulbar motor evoked potentials (FCoMEPs) in skull base surgery, and to assess their respective and combined value in predicting postoperative facial nerve outcome.<br />Methods: 80 consecutive patients undergoing skull base surgery were monitored using ipsilateral FCoMEPs and bilateral BR recordings. BR was particularly assessed during stages in which FCoMEPs were limited by stimulus-induced movement. Facial nerve function was evaluated in the immediate postoperative period and at 6 months using the House-Brackmann (HB) scale. Cluster analysis was performed to identify patterns of intraoperative neurophysiological changes and their association with postoperative facial nerve outcome.<br />Results: Monitorability was 98.6% for the BR and 100% for FCoMEPs. 28 patients developed postoperative facial palsy, severe (HB V-VI) in eight cases. Seven of these patients showed significant intraoperative changes in both BR and FCoMEPs, whereas one showed no changes and recovered within days. All patients with mild to moderate dysfunction (HB II-III) recovered during follow-up. No patient with preserved BR at the end of surgery developed long-term facial nerve paresis. A reduction greater than 50% in BR and FCoMEP amplitudes was associated with poor facial nerve outcome (HB IV-VI).<br />Conclusions: Preserved BR and FCoMEPs are associated with favorable postoperative facial nerve outcome, whereas intraoperative loss of both modalities predict moderate to severe and potentially permanent facial nerve dysfunction. Preservation of BR at the end of surgery reliably indicates intact or only transient facial nerve impairment.<br />Significance: We describe novel features of BR that underscore its importance as a complement to FCoMEPs in skull base surgery.<br /> (Copyright © 2026. Published by Elsevier B.V.)
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  Data: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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  Data: <i>Keywords: </i>Blink reflex; Facial corticobulbar motor evoked potentials; Skull base surgery; Transcranial electrical stimulation
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  Data: <i>Date Created: </i>20260706 <i>Date Completed: </i>20260812 <i>Latest Revision: </i>20260812
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        Text: English
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        Type: general
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      – SubjectFull: Facial Nerve physiology
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      – SubjectFull: Intraoperative Neurophysiological Monitoring methods
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