术中肌电监测对累及第四脑室底面肿瘤切除中后组脑神经核团的保护研究

Intraoperative EMG monitoring for protection of the posterior cranial nerves nucleus

目的探讨术中肌电监测在累及第四脑室底面肿瘤切除术中，后组脑神经核团的保护作用。方法2007年2月至2008年4月治疗23例累及第四脑室底面的肿瘤，其中巨大髓母细胞瘤8例，室管膜瘤7例，脑干起源外生性胶质瘤3例，脑干背侧血管网状细胞瘤2例，脑干海绵状血管瘤3例。全部患者通过显微手术切除肿瘤，术中全程监测后组脑神经肌电活动。对患者术后脑神经功能状态、手术过程和监测情况分析。结果肿瘤全切除17例，次全切除6例，无后组脑神经功能障碍6例，轻度后组脑神经损伤13例，中度后组脑神经损伤4例，无严重损伤者。术中全部患者在正常麻醉和肌松药状态下，可以稳定引出各种刺激诱发的后组脑神经核团兴奋性肌电活动。结论术中肌电监测可以有效避免后组脑神经核性损伤，为第四脑室底面肿瘤切除提供客观依据。

Objective In order to protect the posterior cranial nerves nucleus , the intraoperative EMG monintoring was used during the surgical resection of brain tumors related to the forth ventrical floor. Method 23 brain tumors were surgically removed in our hospital from February 2007 to April 2008, which including 8 case of medulloblastoms, 7 enpendymomas, 3 brain stem gliomas. All the tumors were mlcrosurgical removed and intraoperative EMG monitoring was applied daring the operation. The dates of the posterior cranial nerves function, the surgical procedure and EMG monitor changes were analyzed in order to find their relationship. Results 17 tumors were totally removed and 6 subtotally removed. The patients posterior cranial nerves function were protected well in 6 cases, 13 cases of slight dysfunction and 4 cases of moderate dysfunction. There was no serious damage in our group. The myoelectricity induced by the posterior cranial nerve nucleus stimulation could be recorded successfully under normal anesthesia condition. Conclusion The intraoperative EMG monitoring could avoid posterior cranial nerves nucleus damage and provide objective judgment for resection strategy of tumors related to the forth ventrical floor.