No Shinkei Geka. Neurological Surgery[JOURNAL]
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200 papers
[Neuroimaging in Dementia Diagnosis:Up to Date].
Shiino A
No Shinkei Geka · 2025 Sep · PMID 41047644 · Publisher ↗
With the clinical application of monoclonal antibody therapy for Alzheimer's disease (AD), diagnostic techniques are shifting toward molecular-targeted imaging. The development of tracers for positron emission tomography...
With the clinical application of monoclonal antibody therapy for Alzheimer's disease (AD), diagnostic techniques are shifting toward molecular-targeted imaging. The development of tracers for positron emission tomography (PET) targeting abnormal proteins associated with the disease, such as amyloid-beta and tau, has enabled the detection of neuropathological changes in AD in vivo. This study will contribute to the clinical diagnosis, staging, and monitoring of potential therapeutic approaches for AD. In general outpatient care, imaging modalities that employ widely available techniques such as magnetic resonance imaging or single-photon emission computed tomography remain necessary. This article provides a synopsis of the American College of Radiology recommendations concerning the clinical utility of neuroimaging techniques and reviews the temporal progression of in vivo pathologies derived from amyloid and tau PETs. We investigated the methods for distinguishing between the AD continuum and SNAP in patients with mild cognitive impairment using the ADNI database. Accurate assessment of the "cortical signature" is essential for the diagnosis of AD. Voxel-based morphometry is a useful tool because cortical atrophy is associated with the extension of tau PET lesions. Confirmation of cortical atrophy in conjunction with hippocampal atrophy offers diagnostic insights that facilitate the identification of AD.
[Medical Consultations and Neuropsychological Tests].
Karasawa H
No Shinkei Geka · 2025 Sep · PMID 41047643 · Publisher ↗
We are now in an era where neurosurgeons play an active role in the treatment of dementia. One of the most effective ways to gather essential clinical information during the initial consultation is through a structured q...
We are now in an era where neurosurgeons play an active role in the treatment of dementia. One of the most effective ways to gather essential clinical information during the initial consultation is through a structured questionnaire. This helps establish a comprehensive picture of the patient's condition, supports differential diagnosis, and aids in assessing disease severity. With the advent of anti-amyloid-beta antibody therapies, it is now possible to offer targeted treatment for certain types of dementia. Eligibility criteria for administration include a Mini Mental State Examination score of 22-30 for Rekenbi and 20-28 for Kesanra, measured within one month prior to treatment initiation. Additionally, patients should have a Clinical Dementia Rating of 0.5 or 1.
[Molecular Genetics and Protein Molecules in Dementia].
Kano M, Tomita T
No Shinkei Geka · 2025 Sep · PMID 41047642 · Publisher ↗
Alzheimer's disease (AD), the most common cause of dementia, is marked by the pathological accumulation of misfolded proteins in the brain. Its key pathological features include extracellular amyloid β (Aβ) plaques and i...
Alzheimer's disease (AD), the most common cause of dementia, is marked by the pathological accumulation of misfolded proteins in the brain. Its key pathological features include extracellular amyloid β (Aβ) plaques and intracellular tau neurofibrillary tangles, both of which contribute to synaptic dysfunction and neuronal death. Familial AD is linked to mutations in the APP, PSEN1, or PSEN2 genes, which promote increased Aβ production or aggregation. In contrast, frontotemporal dementia (FTD), including FTDP-17, is associated with MAPT mutations that lead to tau fibril accumulation independent of Aβ pathology. Recent advances in cryo-electron microscopy (cryo-EM) have revealed disease-specific conformations of Aβ and tau fibrils at atomic resolution, highlighting the role of structural polymorphism in disease progression. Aβ contributes to synaptic deficits and activates glial cells, thereby initiating neuroinflammatory responses. Genetic risk factors such as APOE and TREM2 influence these pathological processes. Transgenic mouse models carrying familial mutations have replicated certain aspects of AD pathology. However, most models fail to fully reproduce the human-like filament structures or the sequential progression from Aβ to tau pathology. Novel knock-in models, combined with cryo-EM-based validation, now provide a more accurate platform for studying disease mechanisms and developing targeted therapies.
[Neuropathology of Argyrophilic Grain Disease].
Saito Y
No Shinkei Geka · 2025 Sep · PMID 41047641 · Publisher ↗
Dementia is classified into various types with corresponding underlying pathologies, including Alzheimer's disease, dementia wiht Lewy bodies, and vascular dementia; final diagnosis is often possible only after a patholo...
Dementia is classified into various types with corresponding underlying pathologies, including Alzheimer's disease, dementia wiht Lewy bodies, and vascular dementia; final diagnosis is often possible only after a pathological examination during an autopsy. Furthermore, older adults often have comorbid pathologies that make clinical diagnosis even more difficult. While protein-targeted treatments are emerging, different dementia types have varying pathologies and prognoses, necessitating efforts to improve diagnostic accuracy while the patient is alive. To achieve this, autopsy diagnosis information must be correlated with clinical biomarker data.
[Classification and Clinical Characteristics of Dementia].
Tamaoka A
No Shinkei Geka · 2025 Sep · PMID 41047640 · Publisher ↗
Community-based surveys conducted in Japan investigating the prevalence of dementia and its underlying causes revealed that dementia of Alzheimer's type (DAT) is the most common, followed by vascular dementia (VaD), deme...
Community-based surveys conducted in Japan investigating the prevalence of dementia and its underlying causes revealed that dementia of Alzheimer's type (DAT) is the most common, followed by vascular dementia (VaD), dementia with Lewy bodies (DLB), mixed dementia, and other conditions including frontotemporal lobar degeneration (FTLD). Accurate differential diagnosis of these disorders requires clarification of their clinical characteristics. The initial symptoms of DAT typically include recent memory loss, episodic memory impairment, and temporal disorientation. Behavioral and psychological symptoms often observed in DAT include delusions of theft, "saving appearance" responses, and head-turning signs. Vascular dementia develops in association with cerebrovascular disease and frequently exhibits a stepwise progression. DLB is characterized by core clinical features such as cognitive fluctuations, visual hallucinations, parkinsonism, and REM sleep behavior disorder. Diagnostic tools such as Iodine-metaiodobenzylguanidine (MIBG) myocardial scintigraphy and dopamine transporter (DAT) imaging may aid in diagnosis. In Parkinson's disease with dementia (PDD), cognitive impairment appears more than one year after the onset of parkinsonism. FTLD involves degeneration of the frontal and temporal lobes, leading to prominent changes in personality, behavior, and language function. Several subtypes of FTLD exist depending on the affected brain region, including the behavioral variant of frontotemporal dementia, semantic dementia, and progressive non-fluent aphasia. Idiopathic normal-pressure hydrocephalus (iNPH) is characterized by gait disturbance, urinary incontinence, and dementia, resulting from an abnormal accumulation of cerebrospinal fluid. Pathologically confirmed cases of DLB and progressive supranuclear palsy (PSP) may occasionally present with symptoms resembling iNPH.
[Dementia and Mild Cognitive Impairment: An Overview].
Wada K
No Shinkei Geka · 2025 Sep · PMID 41047639 · Publisher ↗
Dementia and mild cognitive impairment (MCI) are common and increasingly encountered clinical syndromes in neurology and neurosurgery, especially in an aging society. With Japan undergoing a rapid demographic shift, addr...
Dementia and mild cognitive impairment (MCI) are common and increasingly encountered clinical syndromes in neurology and neurosurgery, especially in an aging society. With Japan undergoing a rapid demographic shift, addressing cognitive decline in older adults has become an urgent public health concern. This review provides an overview of dementia and MCI, focusing on the epidemiology, definition, etiology, disease progression, diagnosis, treatment, and post-diagnostic support. Through this discussion, we aim to offer practical insights for neurosurgeons and other specialists caring for patients with cognitive impairment.
[Radiomics in Practice and Its Basic Theory for Neurosurgeons].
Kinoshita M, Kishima H
No Shinkei Geka · 2025 Jul · PMID 40831120 · Publisher ↗
Medical images, including magnetic resonance imaging scans, are composed of numerical data, making them well-suited for machine learning and statistical approaches such as deep learning and radiomics. While qualitative a...
Medical images, including magnetic resonance imaging scans, are composed of numerical data, making them well-suited for machine learning and statistical approaches such as deep learning and radiomics. While qualitative analysis of neurological images may have been sufficient for research a decade ago, current standards increasingly demand some level of quantitative analysis. Although the term "radiomics" may imply complex mathematical processing or advanced programming, its foundational concepts are surprisingly accessible, with origins tracing back to 1973. The mathematical formulas used in radiomic feature are generally within the scope of high school-level mathematics. This paper provides a framework for individuals keen on integrating radiomics into their analytical methodologies, structured in the following manner: In Section II a detailed, methodical example of the procedures involved in conducting radiomic analysis is provided. Section III provides a brief overview of the historical development of radiomics. Sections IV and V explore the two image feature concepts that underpin radiomics: the gray level co-occurrence matrix and the gray level run length matrix, providing readers a deeper understanding of the significance of the calculated image features.
[Management of Neurofibromatosis Type 2].
Fujii M
No Shinkei Geka · 2025 Jul · PMID 40831119 · Publisher ↗
Surgical and radiotherapeutic interventions for vestibular schwannomas in patients with neurofibromatosis type 2 (NF2) generally yield less favorable outcomes than in sporadic unilateral cases, often hindering hearing pr...
Surgical and radiotherapeutic interventions for vestibular schwannomas in patients with neurofibromatosis type 2 (NF2) generally yield less favorable outcomes than in sporadic unilateral cases, often hindering hearing preservation. Managing NF2 entails a lifelong series of complex decisions, repeatedly weighing functional preservation against impairment and surveillance against invasive therapeutic interventions. For both patients and their physicians, a critical issue lies in how to maximize functional preservation while simultaneously securing long-term survival. Auditory reconstruction using implantable auditory devices should be considered in cases of severe bilateral hearing loss. In patients with preserved cochlear nerve integrity, cochlear implantation is effective, and treatment strategies should be planned with this option in mind. Clinical trials of bevacizumab for pharmacological treatment are currently ongoing in Japan, and the clinical application of anti-vascular endothelial growth factor receptor vaccine therapy is anticipated.
[Molecular Pathogenesis, Genetic Profiles, and Therapeutic Strategies for NF2-Related Schwannomatosis].
Teranishi Y, Miyawaki S, Saito N
No Shinkei Geka · 2025 Jul · PMID 40831118 · Publisher ↗
Neurofibromatosis type 2 (NF2), now redefined as NF2-related schwannomatosis (NF2-SWN), is a hereditary tumor syndrome characterized by bilateral vestibular schwannomas, multiple meningiomas, and other central nervous sy...
Neurofibromatosis type 2 (NF2), now redefined as NF2-related schwannomatosis (NF2-SWN), is a hereditary tumor syndrome characterized by bilateral vestibular schwannomas, multiple meningiomas, and other central nervous system tumors. The revised diagnostic criteria incorporate genetic testing and consideration of somatic mosaicism, enabling a more accurate and earlier diagnosis. A strong genotype-phenotype correlation has been established: truncating mutations are associated with an earlier onset and severe clinical course, whereas missense or splice-site mutations are often linked to milder phenotypes and better functional outcomes. Immune and molecular profiling have revealed distinct subtypes of vestibular schwannomas and meningiomas, reflecting differences in tumor behavior and therapeutic responses. In young patients presenting with unilateral vestibular schwannoma, clinicians should remain alert to the possibility of NF2-SWN and consider surveillance based on progression and genetic background. Targeted therapies-including bevacizumab, brigatinib, and vascular endothelial growth factor -A vaccines-have shown promise, particularly in refractory cases. Although routine intensive surveillance is not universally required, early genetic screening and long-term follow-ups may benefit select individuals. The comprehensive integration of genetic, pathological, and immunological data is essential for advancing personalized treatment strategies for NF2-SWN.
[Plastic Surgical Reconstruction Treatments to Achieve Early and Maximal Improvement in Both Aesthetic and Functional Quality of Life for Patients with Facial Paralysis].
Watanabe Y
No Shinkei Geka · 2025 Jul · PMID 40831117 · Publisher ↗
Recent advancements in reconstructive surgery for facial paralysis following cerebellopontine angle tumor resection have markedly enhanced early and maximal quality of life restoration. Contemporary management paradigms...
Recent advancements in reconstructive surgery for facial paralysis following cerebellopontine angle tumor resection have markedly enhanced early and maximal quality of life restoration. Contemporary management paradigms employ multidimensional strategies integrating functional and aesthetic rehabilitation, with hybrid approaches (e.g., static brow lift procedures combined with dynamic free muscle transfers) showing superior outcomes. The timing of referral to a facial paralysis specialist plastic surgeon from the onset of paralysis is critical for optimizing reconstructive outcomes and treatment selection; therefore, early consultation with neurosurgery is strongly recommended.
[Radiation Therapy for Cerebellopontine Angle Tumors:In the Standpoint of Gamma Knife Radiosurgery].
Iwai Y
No Shinkei Geka · 2025 Jul · PMID 40831116 · Publisher ↗
Stereotactic radiation therapy, including stereotactic radiosurgery, is a well-established and effective treatment for cerebellopontine angle tumors such as meningiomas, vestibular schwannomas, trigeminal and jugular for...
Stereotactic radiation therapy, including stereotactic radiosurgery, is a well-established and effective treatment for cerebellopontine angle tumors such as meningiomas, vestibular schwannomas, trigeminal and jugular foramen schwannomas, and glomus tumors. It offers high rates of tumor control while preserving neurological function, particularly in tumors smaller than 3 cm, which are ideal candidates for stereotactic radiosurgery. Large tumors or those extending beyond the skull base can also be managed effectively using fractionated stereotactic radiation therapy. As such, a multidisciplinary approach that combines surgical resection with stereotactic radiation therapy is a valuable strategy, especially when functional preservation is a key therapeutic goal.
[Tympanojugular Glomus Tumor/Tympanojugular Paraganglioma].
Takata Y
No Shinkei Geka · 2025 Jul · PMID 40831115 · Publisher ↗
Glomus tumors, also known as paragangliomas, were previously classified as benign tumors; however, the WHO classification of endocrine and neuroendocrine tumors 4 edition no longer classified paragangliomas as benign and...
Glomus tumors, also known as paragangliomas, were previously classified as benign tumors; however, the WHO classification of endocrine and neuroendocrine tumors 4 edition no longer classified paragangliomas as benign and malignant given any lesion can have metastatic potential. Temporal bone glomus tumors are classified into glomus tympanicum tumors and glomus jugulare tumors. Complete surgical resection is preferred for glomus tympanicum tumors whereas, for glomus jugulare tumors, it is necessary to evaluate age, tumor extension, hearing, and neurological symptoms to determine treatment strategy. In cases of catecholamine production, cranial nerve paralysis, young age, and gene mutations, surgery should be considered. The infratemporal fossa type A approach is one of the main surgical approaches for glomus jugulare tumors. Management of glomus jugulare tumors requires a thorough understanding of pathophysiology of the tumor including biochemistry, genetics, and metastasis. Surgery, radiotherapy, and active surveillance are treatment options, and should be individualized to patients to maintain quality of life.
[Surgical Strategy for Cerebellopontine Angle Epidermoid Cysts].
Sakamoto H, Kohno M
No Shinkei Geka · 2025 Jul · PMID 40831114 · Publisher ↗
Intracranial epidermoid cysts are congenital benign tumors; however, there is a long-term risk of recurrence if the tumor capsule is left behind perioperatively. Additionally, in cerebellopontine angle surgery, in which...
Intracranial epidermoid cysts are congenital benign tumors; however, there is a long-term risk of recurrence if the tumor capsule is left behind perioperatively. Additionally, in cerebellopontine angle surgery, in which cranial nerves and blood vessels are densely concentrated, cranial nerve functions must be preserved besides radical removal of the tumor capsule. Particularly, the optimal surgical field should be obtained under direct visualization to avoid cranial nerve damage due to manipulation over cranial nerves and leaving the tumor behind in the blind spot of the surgical field. Therefore, besides the use of intraoperative monitoring, high surgical skills are required to use four skull base surgical approaches, such as lateral suboccipital retrosigmoid approach (LSO), anterior transpetrosal approach (ATP), combined transpetrosal approach, and ATP and LSO, depending on the size and progression of the tumor. Moreover, this disease should be treated at a specialized facility for skull base surgery.
[Surgical Management for Hypoglossal Schwannoma].
Nonaka Y
No Shinkei Geka · 2025 Jul · PMID 40831113 · Publisher ↗
Hypoglossal schwannomas are extremely rare benign tumors arising from Schwann cells of the 12 cranial nerve. Surgical management of hypoglossal schwannomas requires detailed knowledge of the anatomy around the lower cere...
Hypoglossal schwannomas are extremely rare benign tumors arising from Schwann cells of the 12 cranial nerve. Surgical management of hypoglossal schwannomas requires detailed knowledge of the anatomy around the lower cerebellopontine angle (CPA), the craniovertebral junction (CVJ), and high cervical regions. If a tumor extends through the hypoglossal canal to the extracranial space, the canal is exposed by drilling the posterior half of the occipital condyle (OC), maintaining craniovertebral stability. Based on our experience and a literature review, we proposed the following modified grading scale to facilitate surgical planning: Type A, intradural tumors; Type B, dumbbell-shaped tumors; Type C, extracranial tumors; and Type D, peripheral tumors. The standard lateral suboccipital approach without opening the foramen magnum (FM) does not always provide adequate operative exposure for intradural type tumors. The transcondylar approach with FM opening and high cervical exposure allows gross total resection of dumbbell-shaped tumors. This specific skull base approach consists of an extended lateral suboccipital craniectomy with partial removal of the OC, which provides a wider view of the lower CPA without excessive cerebellar retraction. Key techniques leading to good outcomes are drilling of the OC, soft tissue dissection around the vertebral artery, and accurate exposure of the anterolateral CVJ.
[Jugular Foramen Schwannoma].
Furuse M, Futamura G, Yagi R … +7 more , Fukumura M, Hiramatsu R, Kameda M, Nonoguchi N, Kawabata S, Takami T, Wanibuchi M
No Shinkei Geka · 2025 Jul · PMID 40831112 · Publisher ↗
Jugular foramen schwannoma is a rare intracranial tumor, with few opportunities for surgeons to perform tumor excision. This study aimed to provide an outline of jugular foramen schwannoma and our surgical strategy for t...
Jugular foramen schwannoma is a rare intracranial tumor, with few opportunities for surgeons to perform tumor excision. This study aimed to provide an outline of jugular foramen schwannoma and our surgical strategy for this tumor. The surgical approach depends on tumor growth patterns with or without extracranial extension. In our institute, a lateral suboccipital retrosigmoid approach is used for intracranial tumors, and mastoidectomy is added for extracranial tumors. For accuracy and safety, neuronavigation and intraoperative neurological monitoring are applied to assist surgery. Herein details of surgical procedures are described. Because functional preservation is prioritized in surgery, intracapsular removal is recommended to prevent adhering cranial nerves from being injured by direct manipulation. Stereotactic radiosurgery has also shown good tumor control. Therefore, the goal of treatment is to achieve good tumor control without deterioration of neurological status during a patient's lifetime using both microsurgery and stereotactic radiosurgery. When considering patient-specific factors such as age and tumor size, less invasive skull base surgery is still necessary to treat jugular foramen schwannoma, for which neurosurgeons require knowledge of the anatomy around the jugular foramen and skills specific to such surgery.
[Facial Nerve Schwannomas].
Matsushima K, Kohno M
No Shinkei Geka · 2025 Jul · PMID 40831111 · Publisher ↗
Facial nerve schwannomas (FNSs) are rare, benign tumors that can arise along segments of the facial nerve, including the cerebellopontine angle, internal auditory canal, middle fossa, and temporal bones. Although traditi...
Facial nerve schwannomas (FNSs) are rare, benign tumors that can arise along segments of the facial nerve, including the cerebellopontine angle, internal auditory canal, middle fossa, and temporal bones. Although traditionally managed with gross total resection and facial nerve reconstruction, the resulting facial nerve palsy has prompted a paradigm shift toward functional preservation. Based on>70 surgical cases, we established a tailored strategy based on preoperative facial nerve function and intraoperative facial nerve electromyograms. Patients with mild-to-moderate palsy underwent facial nerve preservation surgery with subtotal resection and osseous decompression under continuous intraoperative monitoring to preserve and improve facial nerve function. Patients with severe palsy underwent total resection with nerve reconstruction. We proposed a practical five-type classification based on the primary tumor location to guide the surgical approach. Cerebellopontine angle-type FNSs may present without facial symptoms, mimicking vestibular schwannomas, particularly if the labyrinthine segment or geniculate ganglion is not involved. In such cases, radical resection should be avoided to ensure functional preservation. To balance long-term tumor control with optimal facial nerve function, comprehensive surgical expertise is required, including detailed anatomical knowledge, diverse skull-base approaches, intraoperative monitoring, nerve reconstruction techniques and flexible surgical planning that allows for intraoperative modification.
[Surgical Strategies for Trigeminal Schwannomas].
Shibao S
No Shinkei Geka · 2025 Jul · PMID 40831110 · Publisher ↗
Trigeminal schwannomas are rare, benign tumors with diverse extension patterns along the trigeminal nerve, which significantly influence surgical approach selection. This article presents strategies for selecting optimal...
Trigeminal schwannomas are rare, benign tumors with diverse extension patterns along the trigeminal nerve, which significantly influence surgical approach selection. This article presents strategies for selecting optimal approaches based on tumor location, classified into middle, posterior, and extracranial compartments. Commonly used approaches include the anterior transpetrosal, epidural and interdural approaches, and recently introduced minimally invasive techniques, such as the endoscopic endonasal transmaxillary-pterygoid and transorbital approaches. The anatomical accessibility, safety, and feasibility of each technique are discussed. A detailed understanding of the trigeminal nerve's membranous anatomy, including the inner reticular layer and Meckel's cave, enables subcapsular dissection while preserving functional neural structures. This article describes practical techniques, including multilayer skull base reconstruction, venous preservation modifications, and intraoperative neurophysiological monitoring, to mitigate complications, such as venous injury, cerebrospinal fluid leakage, and cranial nerve dysfunction. Additionally, it offers a comprehensive overview of the decision-making and technical nuances essential for safe and effective resection of trigeminal schwannomas in complex skull base regions.
[Cerebellopontine Angle Meningioma].
Goto T
No Shinkei Geka · 2025 Jul · PMID 40831109 · Publisher ↗
Cerebellopontine (CP) angle meningiomas are surgically challenging because of their deep-seated location and proximity to the cranial nerves and vessels. Surgical approaches suitable for treating these tumors are describ...
Cerebellopontine (CP) angle meningiomas are surgically challenging because of their deep-seated location and proximity to the cranial nerves and vessels. Surgical approaches suitable for treating these tumors are described in detail in this article. CP angle meningiomas can be classified into six subtypes based on the tumor attachment location: 1)petrotentrial, 2)anterior petrous, 3)posterior petrous, 4)petroclival, 5)inferior petroclival or jugular tubercle, and 6)pure clival meningioma. The suitable approach for each subtype is described.
[Management of Vestibular Schwannoma by Otolaryngologists].
Oishi N
No Shinkei Geka · 2025 Jul · PMID 40831108 · Publisher ↗
Small-to-medium-sized vestibular schwannomas are frequently managed initially by otolaryngologists because hearing loss, tinnitus, and dizziness, the most common presenting symptoms, lead patients to seek otolaryngologic...
Small-to-medium-sized vestibular schwannomas are frequently managed initially by otolaryngologists because hearing loss, tinnitus, and dizziness, the most common presenting symptoms, lead patients to seek otolaryngologic care. Surgical intervention is often considered for patients aged<50 years, whereas radiotherapy is recommended for those aged>70 years. Patient preferences are crucial in treatment decisions. For small-to-medium-sized tumors, complete facial nerve preservation is a primary surgery goal. Surgical approach selection depends on the tumor size and patient's hearing status, with options including the middle cranial fossa, translabyrinthine, and retrolabyrinthine approaches.
[Acoustic Neuroma:Surgical Strategy Using Intraoperative Monitoring and Trend Graphs from the Neurosurgery Perspective].
Nakatomi H
No Shinkei Geka · 2025 Jul · PMID 40831107 · Publisher ↗
This study assessed the efficacy of combining preoperative three-dimensional (3D) fusion imaging with continuous intraoperative neurophysiological monitoring to enhance the anatomical and functional visualization of coch...
This study assessed the efficacy of combining preoperative three-dimensional (3D) fusion imaging with continuous intraoperative neurophysiological monitoring to enhance the anatomical and functional visualization of cochlear and facial nerves during acoustic neuroma surgery. Data from 282 consecutive patients (2006-2023) were analyzed. In all cases, dorsal cochlear nucleus action potential (DNAP) and facial nerve root evoked electromyography (FREMAP) were continuously monitored. A novel system was implemented for real-time waveform visualization, tracking amplitude trends, and displaying nerve preservation rates, allowing for immediate identification of neural deterioration, causative maneuvers, and responses to surgical interventions. Preoperative 3D fusion imaging was performed in 199 cases, and nerve trajectory visualization was achieved in 65% of these cases. A comprehensive database integrating clinical and intraoperative data was created, and multivariate analyses was performed to identify predictors of postoperative function. Final DNAP and FREMAP preservation rates were significantly associated with hearing and facial nerve outcomes, respectively. Optimal DNAP and FREMAP thresholds, as determined using receiver operating characteristic (ROC) analysis, were ≥ 35.5% and ≥ 58.5%, respectively. These findings support the utility of real-time, continuous neurophysiological monitoring and preoperative imaging in improving nerve preservation. The surgical techniques and monitoring strategies are demonstrated in the accompanying video.
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