动眼神经监测在颅底肿瘤切除术中的应用

Intraoperative ocuiomotor nerve monitoring during skull base tumor surgery

目的探索在颅底肿瘤手术中采用神经电生理监测的方法保护动眼神经。方法选择2006年1月至2012年1月天津市环湖医院神经外科收治的35例颅底肿瘤患者，其中男22例，女13例，平均年龄（43±12）岁。利用神经电生理进行术中动眼神经监测，并且用同时期收治的未经监测的26例颅底肿瘤作为对照组，其中男16例，女10例，平均年龄（40±14）岁。观察两组患者术后动眼神经的损伤情况，评价监测效果。结果监测组患者术后出现动眼神经损伤2例，1例表现为患侧眼球略外展位伴轻度复视，术后1个月恢复。另1例表现为患侧瞳孔散大、直接光反射消失伴眼睑下垂，随访6个月后恢复。对照组患者术后出现动眼神经损伤6例，其中5例较轻，术后1个月恢复，1例随访1年后仍未恢复。结论神经电生理监测对于颅底肿瘤手术中动眼神经的保护起到重要的作用。

Objective To explore the intraoperative oculomotor nerve monitoring during skull base tumor surgery for injury avoidance. Methods The study was conducted from January 2006 to January 2012. Monitoring group：35 skull base tumor operations were monitored by neurophysiology （22 males and 13 females）. Control group ：26 skull base tumor operations without intraoperative monitoring were treated with microsurgery alone （16 males and 10 females）. The prognoses of different groups were evaluated. Results Monitoring group ：2 cases had injury of oculomotor nerve. One of them suffered mild diplopia and recovered one months later. Another one had blepharoptosis and mydriasis, reaction to light was absent and recovered six months later. Control group ：6 cases had injury of oculomotor nerve. Five of 6 cases recovered six months later. And one showed no recovery after a 1-year follow-up. Conclusion Intraoperative monitoring of oculomotor is essential for the protection of oculomotor nerve during skull base tumor surgery.