听神经瘤术中面部肌肉肌电图及BAEP的监测与面听神经功能保留:400例临床研究

Intraoperative Monitoring of Electromyogram of Facial Muscles and Brain-stem Auditory Evoked Potential and Preservation of Facial and Acoustic Nerves Functions in patients with Acoustic Neuromas:a Analysis of 400 Cases

目的总结听神经瘤术中监测面部肌肉自发与诱发肌电图和脑干听觉诱发电位(BAEP)的经验,分析术中面、听神经解剖功能保留的方法及影响因素。方法使用美国Nicolet公司生产的Viking-IV型和Axon公司的EpochXP型多导术中监测仪,对收治的400例听神经瘤患者进行了术中监测面部肌肉自发与诱发肌电图和BAEP。手术切除肿瘤,术后对患者进行面、听神经功能评估。结果肿瘤全切388例(97.70%),次全切9例,死亡3例。本组病人面神经解剖保留率为95.97%,功能保留率为91.94%。术后主要并发症包括完全性永久性面瘫11例,面部麻木23例,角膜溃疡18例,耳鸣29例,后经颅神经瘫痪28例,轻偏瘫3例,听力完全丧失139例。结论通过面部肌肉肌电图及BAEP的监测,可以准确判断颅神经的位置,最大程度避免颅神经的损伤。术中面部肌肉自发与诱发肌电图和BAEP监测,对听神经瘤外科手术的安全性提供了一定的保障,减少了手术的风险,使用得当可降低手术的致残率,应该成为听神经瘤手术的常规工作。

Objectives To summarize the experience in intraoperatively monitoring the facial muscles spontaneous and evoked electromyogram （FMSEEMG） and brain-stem auditory evoked potential （BAEP） and to analyze the methods of the preservation of the facial and acoustic nerve functions and factors influencing them in the patients with acoustic neuromas. Methods The clinical data of 400 patients with acoustic neuromas who underwent surgery, in which FMSEEMG and BAEP were monitored by Viking-Ⅳ type muhichannel monitoring equipment made by Nieolet Company in USA and Epoch XP type muhichannel monitoring equipment made by Axon Company in USA, from June, 1995 and May, 2008, were analyzed retrospectively. Results Of 397 patients with acoustic neuromas who survived, 388 received the total resection of the neuromas, and 9 subtotal. Three patients died after the surgery. The rate of the preservation of the facial nerve anatomy was 95.97%, and the rate of the preservation of the facial nerve function was 91.94%. The main postoperative complications included facial palsy in 12 patients, facial numb in 23, corneal ulcer in 18, tinnitus in 29, lower cranial nerve palsy in 28, hemiplegia in 3 and complete loss of hearing in 139. Conclusions The correct location of facial and acoustic nerves can be reached and avoid to be injured by the intraoperative monitoring of FMSEEMG and BAEP, which should be routinely performed during the neurosurgery for the acoustic neuroma.