Dear Editor,
We sincerely thank the authors for their insightful comments and constructive feedback. We appreciate their recognition of the conceptual and methodological contributions of our study. Below, we address each point in detail.
We agree that the relationship between intraoperative sensory-masseter response (SMR) findings and long-term pain relief warrants further investigation [1]. In the present study, SMR was primarily designed as a localization tool for neurovascular compression, rather than a prognostic marker. Although a strong spatial association between SMR positivity and compression sites was observed (P < 0.001), sustained pain relief likely depends on additional mechanisms, such as remyelination and central sensitization, which are not fully captured by intraoperative electrophysiological signals. We acknowledge this limitation and agree that it warrants further investigation.
We also appreciate the important points regarding reproducibility, comparison with existing monitoring techniques, and intraoperative applicability. While SMR was successfully recorded in 82.4% of cases, its generalizability across centers may be influenced by variability in surgical exposure and neurophysiological expertise, despite the detailed stimulation and recording parameters provided in our study. Standardized protocols with clearly defined stimulation thresholds and acquisition criteria are essential. Compared with conventional techniques, such as blink reflex and brainstem auditory evoked potentials, which primarily serve protective roles, SMR offers direct functional mapping of the trigeminal sensory root, with strong spatial specificity reflected by significantly lower stimulation thresholds at compression sites. Although SMR-positive regions showed high concordance with surgically identified compression sites, the technique was not used to guide real-time decompression in this study.
Future studies should focus on multicenter, prospective validation with standardized protocols, along with longitudinal outcome assessment and evaluation of its role in intraoperative decision-making, to further define the clinical value of SMR.
We appreciate these valuable comments and consider them important guidance for future work.
Best regards,
On behalf of all authors
Author contribution
A. wrote the main manuscript text. All authors reviewed the manuscript.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Competing interests
The authors declare no competing interests.
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References
- 1.Jiang W, Kang Y, Wan H, Lin L, Wu S, Zhu H, Lin X, Liu J, Tan G, Wang Z, Liu X (2026) Electrophysiological monitoring of trigeminal nerve sensory root using sensory-masseter response for microvascular decompression in trigeminal neuralgia. Acta Neurochir (Wien) 168(1):13. 10.1007/s00701-026-06769-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
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Data Availability Statement
No datasets were generated or analysed during the current study.