诱发电位、肌电图在桥小脑角区肿瘤术中的应用及临床意义

The Clinical Value of Evoked Potentials and Electromyogram during Cerebellopontine Angle Surgery

目的通过研究脑干听觉诱发电位(BAEP)及面部肌肉肌电图(EMG)在桥小脑角区肿瘤显微切除手术中的监测变化,对手术操作提前预警,以最大限度地避免损伤重要结构。方法 2009年12月～2010年12月对16例桥小脑角区肿瘤患者,应用双侧BAEP和同侧EMG连续实时监护,根据监测结果对可造成脑干和受累的颅神经功能障碍的操作进行提前预警,观察手术操作对它们的影响。结果桥小脑角区肿瘤术中脑干及其周围手术操作均可以引起BAEP改变,BAEP V波波幅降低,V波峰潜伏期(PL)、Ⅰ～Ⅴ及Ⅲ～Ⅴ波峰间期(IPL)明显延长。术中自发EMG会有不同程度的变化,表现为突发的、多相的高幅电位改变。结论 BAEP的V波PL延长和波幅下降以及Ⅰ～Ⅴ、Ⅲ～Ⅴ波峰间期延长是桥小脑角区肿瘤术中敏感的电生理指标,对其进行监护,可避免术中脑干功能障碍;通过EMG的监测,准确判断颅神经的位置及走行,最大程度避免颅神经的损伤,降低手术伤残率。

Objective Through study the variation of brainstem auditory evoked potential and facial muscles electromyogram monitoring during tumors of cerebellopontine angle microsurgery, supply the information for surgeon in time, reduce the injury of important function as much as possible. Methods From December 2009 to December 2010, through studing retrospectively 16 patients of cerebellopontine angle tumors with bilateral BAEP and ipsilateral EMG in continuous real-time monitoring, in accordance with the monitoring results carry out early warning to avoid factors on the brainstem and affected cranial nerve dysfunction, observe surgical operations on their impact. Results During surgery operation of pontocerebellar angel tumors, operation in and around the brainstem may cause changes in BAEP, BAEP V wave amplitude decreased, V wave PL, Ⅰ - Ⅴ, Ⅲ - Ⅴ IPL was significantly prolonged. During operation the spontaneous EMG had the varying degree changes, Performance was the sudden muhiphase high electric potential changes. Conclusion BAEP extension of the V wave latency and amplitude decrease as well as Ⅰ - Ⅴ, Ⅲ -Ⅴ IPL extended acoustic neuroma are sensitive intraoperative electrophysiological indicators, their care for patients can avoid the intraoperative brainstem dysfunction, the correct location and course of cranial nerves can be reached and avoid to be injured by the intraoperative monitoring of EMG and BAEP, reduce the disability rate of surgery.