Brain-stem auditory evoked responses during microvascular decompression for trigeminal neuralgia: Predicting post-operative hearing loss

Context: The importance of brainstem auditory evoked potential monitoring in reducing hearing loss during microvascular decompression for trigeminal neuralgia is now accepted. However the extent of the changes in the pattern of these potentials and the safe limits to which these changes are relevant in reducing postoperative hearing loss have not been established. Aims: The aim of this study is to quantify these changes and relate these to the postoperative hearing loss. Settings and Design: This study was done at the Walton Centre for neurology and neurosurgery, Liverpool, United Kingdom. The study was designed to give a measure of the change in the wave pattern following microvascular decompression and relate it to postoperative hearing loss. Materials and Methods: Seventy-five patients undergoing microvascular decompression for trigeminal neuralgia had preoperative and postoperative hearing assessments and intraoperative brainstem auditory evoked potential monitoring. Statistical Analysis Used: Chi-square tests. Results: It was found that the wave V latency was increased by more than 0.9ms in nine patients, eight of whom suffered significant postoperative hearing loss as demonstrated by audiometry. It was also seen that progressive decrease in amplitude of wave V showed progressive hearing loss with 25% loss when amplitude fell by 50 and 100% loss when wave V was lost completely. However most of the patients did not have a clinically manifest hearing loss. Conclusions: A per-operative increase in the latency of wave V greater than 0.9 ms and a fall of amplitude of wave V of more than 50% indicates a risk to hearing.