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Shields CB, Shields LB, Jiang YD, et al. BAER suppression during posterior fossa dural opening. Surg Neurol Int. 2015;6:57doi: 10.4103/2152-7806.154775.
Shields, C. B., Shields, L. B., Jiang, Y. D., Yao, T., Zhang, Y. P., & Sun, D. A. (2015). BAER suppression during posterior fossa dural opening. Surgical neurology international, 657. https://doi.org/10.4103/2152-7806.154775
Shields, Christopher B, et al. "BAER suppression during posterior fossa dural opening." Surgical neurology international vol. 6 (2015): 57. doi: https://doi.org/10.4103/2152-7806.154775
Shields CB, Shields LB, Jiang YD, Yao T, Zhang YP, Sun DA. BAER suppression during posterior fossa dural opening. Surg Neurol Int. 2015 Apr 09;6:57. doi: 10.4103/2152-7806.154775. eCollection 2015. PMID: 25883849; PMCID: PMC4399168.
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Surg Neurol Int. 2015 Apr 09;6:57. doi: 10.4103/2152-7806.154775. eCollection 2015.

BAER suppression during posterior fossa dural opening.

Surgical neurology international

Christopher B Shields, Lisa B E Shields, Yi Dan Jiang, Tom Yao, Yi Ping Zhang, David A Sun

Affiliations

  1. Norton Neuroscience Institute, Norton Healthcare, 210 East Gray Street, Suite 1102, Louisville, KY 40202, USA.
  2. Impulse Monitoring Inc., 10420 Little Patuxent Parkway, Suite 250, Columbia, MD 21044, USA.

PMID: 25883849 PMCID: PMC4399168 DOI: 10.4103/2152-7806.154775

Abstract

BACKGROUND: Intraoperative monitoring with brainstem auditory evoked responses (BAER) provides an early warning signal of potential neurological injury and may avert tissue damage to the auditory pathway or brainstem. Unexplained loss of the BAER signal in the operating room may present a dilemma to the neurosurgeon.

METHODS: This paper documents two patients who displayed a unique mechanism of suppression of the BAER apparent within minutes following dural opening for resection of a posterior fossa meningioma.

RESULTS: In two patients with anterior cerebellopontine angle and clival meningiomas, there was a significant deterioration of the BAER soon after durotomy but prior to cerebellar retraction and tumor removal. Intracranial structures in the posterior fossa lying between the tumor and dural opening were shifted posteriorly after durotomy.

CONCLUSION: We hypothesized that the cochlear nerve and vessels entering the acoustic meatus were compressed or stretched when subjected to tissue shift. This movement caused cochlear nerve dysfunction that resulted in BAER suppression. BAER was partially restored after the tumor was decompressed, dura repaired, and bone replaced. BAER was not suppressed following durotomy for removal of a meningioma lying posterior to the cochlear complex. Insight into the mechanisms of durotomy-induced BAER inhibition would allay the neurosurgeon's anxiety during the operation.

Keywords: Brainstem auditory evoked responses; durotomy; internal auditory meatus; posterior fossa brain tumor

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