面神经F波辅助监测听神经瘤显微手术46例临床研究

Clinical research on 46 cases of microoperation for acoustic neurinomas under the F wave assisted electrophysiological monitoring intraoperatively

目的研究全切除听神经瘤并保留面神经功能的方法和术中鼻肌F波辅助监测技术的价值。方法回顾总结了2004年2月至2008年12月用鼻肌F波、TriggeredEMG和OnlineEMG三种技术联合监测的46例听神经瘤手术的治疗结果。对术中各监测指标与术后1d和6个月面神经功能随访结果进行对比分析，并对鼻肌F波与OnlineEMG监测的趋势性进行分析。结果肿瘤全切45例（97．83％），次全切除1例（2．17％），术后死亡1例（2．17％），2例发生脑脊液漏（4．35％），保守治愈。面神经解剖保留率为97．83％，术后6个月面神经功能随访：优良75．56％，中等22．22％，差2．22％。术中鼻肌F波与OnlineEMG监测对结果判定的完全一致率为52．17％，基本相符率为45．65％，完全不一致率为2．17％（X2趋势6．113，P〈0．05）。术中鼻肌F波监测结果与术后6个月面神经功能之间有较好的一致性（K=0．429，P〈0．001）。肿瘤切除后TriggeredEMG监测面神经脑干端／内耳门端刺激电流阈值比和最大波幅比与术后6个月面神经功能也有较好的一致性（K=0．576，P〈0．001；K=0．595，P〈0．001）。结论术中鼻肌F波与OnlineEMG和TriggeredEMG监测在术中判断和术后面神经功能预测上具有良好的协同作用，应联合使用。

Objective To study the methods of how to protect facial nerve function following complete resection of acoustic neurinomas and the value of the techniques of F wave assisted electrophysiological monitoring intraoperatively. Methods Retrospectively summarizing the results of combining three electrophysiological monitoring techniques such as nasal muscle F wave recording, online EMG and triggered EMG to monitor 46 cases of mierooperations for acoustic neurinomas intraoperatively during the period of Feb. 2004 to Dec. 2008. Correlating every intraoperative monitoring index with their follow-up results of facial nerve function 1 day and 6 months after their operations. The tendency of the two continuous monitoring techniques between nasal F wave recording and online EMG of facial muscles has also been studied in this paper. Results Among 46 cases of acoustic neurinomas, 45（97.83 %） tumors have been totally reseeted, and 1（2.17 %） tumor subtotally resected, lcase （2.17 %） died after operation, and 2 （4.35 %） cases occurred the leakage of eerebrospinal fluid（CSF） which have been cured through conservative treatment. The whole anatomic protection rate of facial nerve is 97.83 %, and their functional protection rates 6 months after operation are： HB Ⅰ-Ⅱ, 75.56 %; Ⅲ-Ⅳ, 22.22 % and Ⅴ-Ⅵ, 2.22 %. The completely accordant rate between the intraoperative findings of nasal F wave recording and online EMG is 52.17 %, partially accordant rate is 45.65 %, and totally opposite rate is 2.17 % （X2趋势= 6.113, P 〈0.05）. The intraoperative monitoring indexes in nasal muscle F wave recording are correlated well with the facial nerve function in the 6th month＂ s follow-up （K=0.429, P 〈0.001）. In triggered EMG monitoring after tumors being resected, the stimulus threshold ratio and maximum amplitude ratio of facial nerve between leaving brain stern part and inner acoustic porus part are also correlated well with the facial nerve function 6 months after operation（K=0.576, P 〈0.001; K=0.595, P 〈0.001）. Conclusion Nasal muscle F wave recording cooperated well with online EMG and triggered EMG intraoperatively and correlates well with the postoperative facial nerve function, so they should be routinely applied together intraoperatively.