颞骨岩部胆脂瘤术中面神经完整性监测与减压

Decompression and monitor of facial nerve during cholesteatoma surgery in petrous part of temporal bone

目的：探讨颞骨岩部胆脂瘤术中面神经监测与减压的临床效果。方法：11例颞骨岩部胆脂瘤患者均伴有面瘫，经颅中窝-乳突联合进路行胆脂瘤切除术，其中8例鼓膜穿孔或中耳乳突感染者行乳突腔开放术式；3例岩尖并侵犯中耳乳突但鼓膜完整者行外耳道关闭术式。术中应用神经监护仪行面神经完整性监护，完成颞骨内面神经减压术。面神经功能评价参照House-Brackmann标准。结果：随访3～12个月，11例面神经功能逐渐恢复，1例面瘫恢复到基本正常，9例恢复到轻度，1例恢复到轻中度，均无胆脂瘤复发。结论：颅中窝-乳突联合进路切除颞骨岩部胆脂瘤同期行面神经减压术疗效满意，神经完整性监护有助于术中面神经定位和保护。

Objective：To study the application of facial nerve monitoring and to estimate the therapeutic effectiveness of the total decompression of facial nerve during the surgery for cholesteatoma in petrous bone by middle cranial fossa-mastoid process approach. Method： Eight cases who suffered from chronic suppurative otitis media （cholesteatoma type） in petrous bone were treated with open technique, three other cholesteartoma cases whose tympanic membranes were intact was treated with close technique. Monitoring for facial nerve integrity during operation was applied. Total decompression of facial nerve was performed in all patients. House-Brackmann grading system was used to evaluated the recovery of facial nerve function. Result： Facial paralysis recovered gradually during the period of 3 to 6 months after operation. After 6 to 12 months follow-up in 11 cases, 1 case regained basically normal status,9 cases recovered to mild facial paralysis and 1 case still neededs further follow-up. There was no recurrence of cholesteatoma in all patients. Conclusion：Middle cranial fossa-mastoid process combining approach technique is effective for ch01esteatoma in petrous bone and total decompression of facial nerve at the same stage. Nerve monitor is helpful in orientating facial nerve during operation and in preventing possible damage to the facial nerve.