Handheld cochlear nerve action potential mapping for real-time functional navigation in vestibular schwannoma surgery.

IF 3.8 2区医学 Q1 CLINICAL NEUROLOGY

Journal of neurosurgery Pub Date : 2026-09-04 DOI:10.3171/2026.3.JNS252763

Xiaoyu Li, Xu Gong, Penghao Liu, Hanyi Jiao, Gang Song, Jiantao Liang

{"title":"Handheld cochlear nerve action potential mapping for real-time functional navigation in vestibular schwannoma surgery.","authors":"Xiaoyu Li, Xu Gong, Penghao Liu, Hanyi Jiao, Gang Song, Jiantao Liang","doi":"10.3171/2026.3.JNS252763","DOIUrl":null,"url":null,"abstract":"Objective: Hearing preservation in vestibular schwannoma (VS) surgery remains challenging due to frequent cochlear nerve displacement and the limited reliability of brainstem auditory evoked potentials (BAEPs) once waveforms deteriorate. This study evaluated the feasibility and clinical utility of bipolar handheld cochlear nerve action potential (CNAP) mapping for intraoperative nerve identification and compared its prognostic performance with BAEP monitoring.Methods: In this retrospective single-center cohort, 193 patients with histologically confirmed VS underwent intraoperative auditory mapping between September 2021 and November 2024. Two color-coded bipolar handheld probes were used: one for facial nerve stimulation and the other for near-field CNAP recording along the presumed cochlear nerve course. CNAP responses were considered favorable if waveforms remained stable or decreased by < 50% in amplitude. Functional hearing preservation (American Academy of Otolaryngology-Head and Neck Surgery class A-C) served as the primary endpoint. Logistic regression and receiver operating characteristic (ROC) analyses evaluated predictive performance.Results: CNAP mapping identified the cochlear nerve in 83.4% of cases, significantly higher than intraoperative BAEP elicitation (46.1%; p < 0.001). Favorable CNAP responses were strongly associated with hearing preservation (91.4% vs 8.1%, p < 0.001; adjusted OR 37.0, 95% CI 9.28-217.8). The combined CNAP + BAEP model showed excellent discrimination (area under the ROC curve = 0.91) and good calibration (p = 0.24, Hosmer-Lemeshow test).Conclusions: CNAP mapping enabled real-time functional localization of the cochlear nerve and provided complementary intraoperative functional information. While postoperative hearing remains dependent on the structural integrity of the cochlear nerve, particularly in large tumors, CNAP mapping provides complementary functional information strongly associated with hearing preservation.","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8000,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3171/2026.3.JNS252763","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: Hearing preservation in vestibular schwannoma (VS) surgery remains challenging due to frequent cochlear nerve displacement and the limited reliability of brainstem auditory evoked potentials (BAEPs) once waveforms deteriorate. This study evaluated the feasibility and clinical utility of bipolar handheld cochlear nerve action potential (CNAP) mapping for intraoperative nerve identification and compared its prognostic performance with BAEP monitoring.

Methods: In this retrospective single-center cohort, 193 patients with histologically confirmed VS underwent intraoperative auditory mapping between September 2021 and November 2024. Two color-coded bipolar handheld probes were used: one for facial nerve stimulation and the other for near-field CNAP recording along the presumed cochlear nerve course. CNAP responses were considered favorable if waveforms remained stable or decreased by < 50% in amplitude. Functional hearing preservation (American Academy of Otolaryngology-Head and Neck Surgery class A-C) served as the primary endpoint. Logistic regression and receiver operating characteristic (ROC) analyses evaluated predictive performance.

Results: CNAP mapping identified the cochlear nerve in 83.4% of cases, significantly higher than intraoperative BAEP elicitation (46.1%; p < 0.001). Favorable CNAP responses were strongly associated with hearing preservation (91.4% vs 8.1%, p < 0.001; adjusted OR 37.0, 95% CI 9.28-217.8). The combined CNAP + BAEP model showed excellent discrimination (area under the ROC curve = 0.91) and good calibration (p = 0.24, Hosmer-Lemeshow test).

Conclusions: CNAP mapping enabled real-time functional localization of the cochlear nerve and provided complementary intraoperative functional information. While postoperative hearing remains dependent on the structural integrity of the cochlear nerve, particularly in large tumors, CNAP mapping provides complementary functional information strongly associated with hearing preservation.

查看原文本刊更多论文

手持式耳蜗神经动作电位定位在前庭神经鞘瘤手术中的实时功能导航。

目的：由于耳蜗神经移位频繁，脑干听觉诱发电位（BAEPs）波形恶化后的可靠性有限，前庭神经鞘瘤（VS）手术中的听力保护仍然具有挑战性。本研究评估双极手摇耳蜗神经动作电位（CNAP）定位术中神经识别的可行性和临床应用，并将其与BAEP监测的预后效果进行比较。方法：在这个回顾性的单中心队列中，193例组织学证实的VS患者在2021年9月至2024年11月期间进行了术中听觉映射。使用两个彩色编码的双极手持探针：一个用于面神经刺激，另一个用于沿假定的耳蜗神经路线近场CNAP记录。如果波形保持稳定或幅度下降< 50%，则认为CNAP反应有利。功能性听力保护（美国耳鼻喉-头颈外科学会A-C级）作为主要终点。逻辑回归和受试者工作特征（ROC）分析评估了预测效果。结果：CNAP图谱识别耳蜗神经的比例为83.4%，明显高于术中BAEP诱发（46.1%,p < 0.001）。良好的CNAP反应与听力保护密切相关（91.4% vs 8.1%, p < 0.001；调整OR 37.0, 95% CI 9.28-217.8）。CNAP + BAEP联合模型具有良好的判别性（ROC曲线下面积= 0.91）和良好的定标性（Hosmer-Lemeshow检验p = 0.24）。结论：CNAP图谱能够实现耳蜗神经的实时功能定位，并提供术中功能信息的补充。虽然术后听力仍然依赖于耳蜗神经的结构完整性，特别是在大肿瘤中，CNAP制图提供了与听力保存密切相关的补充功能信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of neurosurgery 医学-临床神经学

CiteScore

7.20

自引率

7.30%

发文量

1003

审稿时长

1 months

期刊介绍： The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.