术中神经监测在听神经瘤切除术中对面神经的保护作用

The Role of Intraoperative Facial Nerve Monitoring in Acoustic Neuroma Resection

背景与目的:面神经瘫痪是听神经瘤切除术中最常见的并发症,近年来随着术中神经监测技术的应用,术后面神经功能已得到较好的保护。本研究旨在探讨术中神经监测在听神经瘤手术中对面神经功能的保护作用。方法:分析本院收治手术的57例听神经瘤患者,其中直接显微镜下切除肿瘤(非监测组)35例,显微镜下切除肿瘤过程中使用术中神经监测仪对面神经进行监测(监测组)22例。观察术中面神经实时监测情况,随访所有患者术后面神经功能。结果:术后3个月患者面瘫情况按House-Brackmann面神经功能分级(I^VI级)进行评价,监测组II级2例,III级2例,其余均无面神经功能异常(I级);未监测组II级9例,III级6例,IV级2例,VI级1例,无面神经功能异常者(I级)17例。监测组面神经功能保护良好率明显高于未监测组(P<0.05)。结论:术中神经监测技术可以提前发现面神经的可能位置,辨别面神经,决定粘连于面神经上肿瘤的剥离程度,判断术中面神经功能的保存情况,明显降低面瘫率,对听神经瘤手术的面神经保护有着积极作用。

BACKGROUND ＆ OBJECTIVE： To maintain the anatomic and functional intactness of facial nerve is one of the goal of acoustic neuroma resection. In this article, we investigated the role of intraoperative facial nerve monitoring in acoustic neuroma resection. METHODS： Clinical data of 57 patients with acoustic neuroma treated in our hospital were retrospectively analyzed. Among 57 patients, tumors were removed under microscope without intraoperative facial nerve monitoring in 35 cases and with intraoperative monitoring in 22 cases. Post operative facial nerve function was followed up in all patients. RESULTS： House-Brackmann system was used for evaluating the function of facial nerve 3 months after operation. Among 22 eases with intraoperative facial nerve monitoring, facial nerve intactness was observed in 18 cases, Grade l facial paralysis in 2 cases and Grade II facial paralysis in 2 cases, repcctively. The monitoring group had 2 cases Among 35 eases without intraoperative facial nerve monitoring, intact faical function was observed in 14 eases, Grade I facial paralysis in 12 eases, Grade Ⅱ facial paralysis in 6 cases, grade Ⅲ facial paralysis in 2 eases, and Grade V facial paralysis in 1 ease, respectively.Patients with intraoperative facial nerve monitoring had better performance in facial nerve function than those without monitoring （P〈 0.05）. CONCLUSION： Intraoperative nerve monitoring techniques facilitates the localization and preservation of the facial nerve in acoustic neuroma resection.