Modified Micro-Scissors As Stimulation-Dissection Tool – Technical Note

Background: Preservation of facial nerve function represents a fundamental prerequisite for neurosurgical treatment of pathologies involving the facial nerve within the cerebello-pontine angle. Tools for micro-dissection that simultaneously feature properties of a nerve stimulator and thus improve the safety of dissection around the facial nerve are desirable and have been lacking so far. Case Description: We present a novel utilization of a pair of micro-scissors as a combined stimulation-dissection tool during microvascular decompression of a facial nerve in a case of refractory hemifacial spasm. In anticipation of the imminent risk of facial nerve damage, we opted for an original approach by attaching the monopolar stimulating lead wire of the monitoring system to a pair of micro-scissors. This combination enabled us to use the scissors both as a cutting dissector and, simultaneously, a nerve stimulation probe. Consequently, micro-scissors may be used not only for sharp dissection around cranial nerves but also, simultaneously, as a monopolar stimulation probe that enables real-time feedback about the nerve function in form of audible alarms generated by the stimulation monitor. Conclusion: Modified micro-scissors as a combined stimulation-dissection instrument might enable the surgeon both to perform a real-time monitoring of sharp dissection around cranial nerves.