部分肌松下多组颅神经监护在小脑桥脑角区肿瘤切除术患者中的应用

Intraoperative cranial nerves monitoring under partial neuromuscular relaxation during cerebellopontine angle tumor resection

目的评价全身麻醉下小脑桥脑角区肿瘤切除术患者中，在部分肌松条件下多组颅神经监护的效率。方法70例择期行小脑桥脑角区肿瘤显微手术患者，随机分为两组，一组术中只进行面神经监护（FN组，n=35），另一组则除了面神经外，尚监护三叉神经、舌咽神经或副神经、舌下神经（MN组，n=35）。两组均根据监护结果调整手术操作，患者颅神经监护期间均采用TOF肌松监测，连续输注维库溴铵维持TOF值为3。术前和术后第8天评价所监护神经支配的肌肉功能。结果术中两组患者在TOF=3的部分肌松条件下均能得到清晰可辨的肌电图波形。FN组和MN组术后面神经功能恶化（从H-BⅠ-Ⅱ级至Ⅲ-Ⅳ级）的均增加4例，另外FN组新增1例舌咽神经损伤，而MN组新增1例舌下神经损伤。结论全麻下在部分肌松条件下进行术中多组颅神经监护是可行的，但在小脑桥脑角区肿瘤显微手术中多组神经联合面神经监护似乎并不增加术后短期颅神经的保护效率。

Objective To evaluate the efficacy of multiple cranial nerves monitoring under partial neuromuscular relaxation during cerebellopontine angle （CPA） tumor resection. Methods Seventy elective patients undergoing CPA tumor resection via microneurosurgery were randomly allocated to 2 equal groups： Group FN receiving intraoperative facial nerve （NF） monitoring and Group MN receiving monitoring of multiple nerves： trigeminal nerve, glossopharyngeal nerve, accessory nerve or hypoglossal nerve other than the FN which were considered at risk by the neurosurgeon preoperatively. The manipulation procedure were modified according to cranial nerves monitoring and neuromuscular relaxation was maintained at train of four stimulation （TOF） = 3 by continuous vencronium infusion during the acoustic neuroma resection. The function of the cranial nerves monitored were evaluated preoperatively and 8 days postoperatively. Results Discernable and legible images of electromyographic wave complex were obtained during cranial nerve mapping and monitoring under intraoperative partial neuromuscular relaxation form all the patients. The facial nerve function of 4 patients exacerbated （from H-B gradeⅠ -Ⅱ to grade Ⅲ-Ⅳ ） in both groups, and one new glossopharyngeal nerve function deficiency was found in Group FN, and one new hypoglossal nerve function deficiency was found in Group MN postoperatively. Conclusion Intraoperative cranial nerves monitoring under partial neuromuscular relaxation is feasible. Multiple cranial nerves combined with facial nerve monitoring seems unable to increase the short-term protective effects of nerve function after CPA tumor resection.