面肌诱发电位在巨大听神经瘤术中面神经保护的研究及预后分析

Protective effect of facial muscle evoked potentials on facial nerve function in large acoustic neuroma surgery and prognostic analysis

目的探讨经头皮颅骨刺激面肌诱发电位(TCeMEP)在巨大听神经瘤切除术中的面神经保护作用。方法对28例巨大听神经瘤术中监测TCeMEP,并比较其变化和术后面肌功能的关系。结果16例术后TCeMEP下降大于75%,其中9例明显面瘫,7例轻度面瘫;12例术后TCeMEP下降小于75%,其中2例明显面瘫,7例轻度面瘫,3例基本正常。两组明显面瘫率经2χ检验,P<0.05。结论TCeMEP可以术中实时监测全部面肌传导通路的功能,为术中保护面神经功能提供可靠的电传导依据。TCeMEP波幅下降75%可以作为术后可能发生明显面瘫的警戒点。

objective To exp lore the protective function of facial muscle motor evoked potentials induced by transcranial stimulation （TCeMEP） in the large acoustic neuroma surgery. Method TCeMEP of 28 patients with large acoustic neuroma were monitored during the surgery, and the relationship between the change of TCeMEP and the postoperative function of facial nerve was comparatively studied. Result The TCeMEP amplitude decreased more than 75% in 16 cases, in which 9 patients had obvious facial paralysis and 7 mild facial paralysis. The TCeMEP amplitude decreased less than 75% in 12 patients, of whom 2 had obvious facial paralysis and 7 mild facial paralysis, and the rest 3 were normal （P〈0.05）. Conclusion TCeMEP can be used to judge the function of the facial nerve in real time, and provide electrophysiological evidence for the preservation of facial nerve in the surgery. Decrease by 75 % of TCeMEP amplitude should be an alarm level for possible severe facial paralysis.