大型听神经瘤术中面神经功能的监护和保留

Intraoperative monitoring and preservation of facial nerve function during large acoustic neuroma surgery

目的：研究在大型听神经瘤手术中，面肌肌电图(EMG)、脑干听觉诱发电位(BAEP)监护在面神经保留中的作用。方法：对16例大型听神经瘤患者经枕下入路行显微手术全切除肿瘤，术中同时监测面肌EMG、BAEP。结果：肿瘤全切率100%，无手术死亡，面神经解剖保留率94%，功能保留良好率81%。术末刺激强度≤04 mA者提示预后良好。结论：大型听神经瘤的手术中，通过面肌EMG、BAEP监护，显微手术操作时可避免损伤神经，显著提高面神经的功能保留率，并提供客观指标提示预后。

Objectives To study the effect of intraoperative EMG and BAEP monitoring on protection of the facial nerve during large acoustic neuroma surgery.Methods The tumors were removed completely by way of suboccipital approaches in 16 patientes with large acoustic neuromas and the facial electomyography (EMG) and brainstem auditory evoked potential(BAEP) monitoring was done during operation.Result Total tumor removal rate was 100% with no patient died. The anatomical preservation rate of facial nerve was 94%. Good outcome (mHB degree＞Ⅱ) of facial nerve function was found in 81% of cases which showed good prognosis with stimulation threshold less than 0.4 mA at the end of the operation.Conclusions During operation on large acoustic neuroma, intraoperative monitoring of ENG and BAEP might guide the sergery，and increase the function preservation rate of the facial nerve and provide objective index for clinical prognosis.