听神经瘤术中面神经功能监测22例临床研究

Clinical investigation on 22 cases of acoustic neuromas with intraoperative facial nerve function monitoring

目的探讨术中面神经监测对术后面神经功能保留的影响。方法使用英国牛津公司Medelec神经生理术中监测仪,对22例听神经瘤术中进行面神经自发面肌电图及电刺激诱发面肌电图监测。结果通过术中监测自发肌电图结合电刺激诱发肌电图可以精确判断面神经的位置;本组22例大中型听神经瘤,术后6月面神经H-B分级Ⅰ-Ⅱ级13例,Ⅲ级2例,Ⅳ级1例,Ⅴ级1例,Ⅵ级5例。结论术中肌电图监测可以提示面神经的位置和走行,为手术时避免损伤神经提供依据;肿瘤切除后可帮助确认面神经结构是否完整;全切肿瘤后引出肌电图的最小电刺激强度与面神经预后密切相关。

Objective To explore the influence of intraoperative monitoring on postoperative facial nerve function in acoustic neuroma patients.Methods The facial nerve spontaneous and stimulated electromyography（EMG） of 22 cases of acoustic neuromas were monitored by Oxford company Medelec intraoperative neurophysiologic monitor.Results The position of facial nerve was correctly located via intraoperative monitoring spontaneous EMG combined with stimulated EMG.According to House-Brackmann facial nerve grading system,the facial nerve was gradeⅠ-Ⅱin 13 of 22 cases after operation for 6 months,grade Ⅲ in 2 cases,grade Ⅳ in one case,grade Ⅴin one case,and grade Ⅵ in 5 cases.Conclusion Intraoprative electromyography（EMG） could reveal the position of facial nerve and avoid the nerve injury.EMG could help confirm the integrity of the postoperative facial nerve.The minimal stimulated intensity which can derive EMG is related with the prognosis of facial nerve function after total resection of the tumor.