Handheld cochlear nerve action potential mapping for real-time functional navigation in vestibular schwannoma surgery.
Cochlear nerve action potential mapping identified the cochlear nerve more often than brainstem auditory evoked potentials in vestibular schwannoma surgery
Handheld cochlear nerve action potential mapping for real-time functional navigation in vestibular schwannoma surgery.
Hearing preservation in vestibular schwannoma (vestibular schwannoma) surgery remains challenging due to frequent cochlear nerve displacement and the limited reliability of brainstem auditory evoked potentials (brainstem auditory evoked potentials) once waveforms deteriorate.
This study evaluated the feasibility and clinical utility of bipolar handheld cochlear nerve action potential (cochlear nerve action potential) mapping for intraoperative nerve identification and compared its prognostic performance with brainstem auditory evoked potentials monitoring.
In this retrospective single-center cohort, 193 patients with histologically confirmed vestibular schwannoma underwent intraoperative auditory mapping between September 2021 and November 2024.
of tumors had the cochlear nerve located by cochlear nerve action potential mapping, versus under half with brainstem auditory evoked potentials
Favorable cochlear nerve action potential 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 cochlear nerve action potential + brainstem auditory evoked potentials model showed excellent discrimination (area under the ROC curve = 0.91) and good calibration (p = 0.24, Hosmer-Lemeshow test).
Cochlear nerve action potential 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, cochlear nerve action potential mapping provides complementary functional information strongly associated with hearing preservation.