面神经实时监测在耳神经外科手术中的应用

Application of intraoperative monitoring to facial nerve in otoneurosurgery

目的探讨面神经实时监测在耳神经外科手术中的应用价值。方法41例耳神经外科手术中使用面神经监测仪,观察术中面神经实时监测情况,并随访术后面神经功能。结果采用House-Brackmann面神经功能分级标准对所有患者进行面神经功能评估。11例听神经瘤患者术前均无面瘫,术后2例出现Ⅲ级面瘫,2个月内恢复;6例外伤性面瘫,术后1年恢复至Ⅰ级者4例;1例贝尔面瘫,术后1年恢复至Ⅲ级;7例颞骨恶性肿瘤,4例术前、术后均无面瘫,3例术前有面瘫者术后恢复至Ⅰ～Ⅲ级;5例岩尖胆脂瘤,2例术前、术后均无面瘫,3例术前有面瘫者II～Ⅲ级,术后9个月恢复正常;2例梅尼埃病患者,1例术后无面瘫,1例术后出现Ⅲ级面瘫,术后半年完全恢复;5例第一鳃沟瘘管及4例颈静脉孔区肿瘤患者术前、术后均无面瘫。结论耳神经外科手术中使用面神经监测可提高面神经保全率,面神经肌电图描记(EMG)刺激电流阈值的大小可为面神经大致走向及功能状况提供参考。

Objective To explore the value of intraoperative monitoring of facial nerve in otoneurosurgery. Methods Facial nerve monitor was used for inspecting the function of facial nerve during operation in 4 1 patients undergoing otoneurosurgery. The postoperative nerve function was followed up. Results House- Brackmann system was used for evaluating the function of facial nerve. Postoperative facial paralysis of grade Ⅲ appeared in 2 of 11 acoustic neuroma patients without preoperative facial paralysis, which disappeared within two months after operation. The function of facial nerve in 4 of 6 cases with traumatic facial paralysis recovered to grade Ⅰ after surgery. The function of 1 patient with Bell＇ s palsy recovered to grade Ⅲ after surgery. Of 7 patients with malignant tumors in temporal bone, no facial paralysis occurred before and after surgery in 4 cases, and preoperative facial paralysis in 3 eases recovered to grade Ⅰ-Ⅲ postoperatively. Of 5 patients with petrous apex cholesteatoma, no facial paralysis occurred before and after surgery in 2 cases, and the postoperative nerve function in 3 patients with preoperative function of grade Ⅱ-Ⅲ returned to normal within 9 months. Of 2 patients with Menier＇ s disease, no postoperative facial paralysis occurred in 1 ease and paralysis of grade Iit occurred in another, which disappeared within 6 months. As for 5 patients with the first branchial fistula and 4 with jugular foramen tumors, there was no facial paralysis before and after surgery. Conclusion The application of facial nerve monitoring to otoneurosurgery can improve facial nerve salvage rate. The threshold current of EMG is useful for exploring the course and the function of facial nerve.