面神经电生理监测下切除大型及巨大听神经瘤

Resection of large and giant vestibular schwannomas under facial neurophysiological monitoring

目的：探讨面神经电生理监测下切除大型及巨大听神经瘤技术。方法回顾分析22例大型及巨大听神经瘤临床资料，在面神经电生理监测下行显微手术切除，术后随访面神经功能。结果肿瘤全切除15例，次全切除7例。面神经自发肌电图在面神经受牵拉、挤压、生理盐水冲洗等操作过程中产生显著放电，刺激肌电图对寻找和辨认面神经具有重要作用。面神经位于肿瘤腹下方7例，腹上方2例，腹侧中部13例。所有病例面神经均解剖保留。术后随访6～42个月，面神经功能（ House-Brackmann分级），H-B分级Ⅰ级11例，Ⅱ级5例，Ⅲ级2例，Ⅳ级4例。结论面神经电生理监测辅助显微手术对术中解剖与功能保留面神经具有重要价值。

Objective To explore the techniques for resection of large and giant vestibular schwannomas under facial nerve monitoring .Methods The data of 22 patients with large and giant vestibular schwannomas underwent the microsurgical resections under facial nerve monitoring were analyzed retrospectivelyy .All patients were followed up and facial nerve function was evaluated .Results Gross total resection was achieved in 15 patients and subtotal in 7.Free-running facial nerve electromyography was elicited while retraction or compressing the FN or irrigating .Stimulated electro-myography was helpful for tracking and identifying the facial nerve .Facial nerve was on the anterior lower third of the tumor in 7 cases, anterior upper third in 2, and anterior middle third in 13.Anato-mical preservation of facial nerve was achieved in all cases .The follow-up from 6 to 42 months postoperatively showed facial nerve function was H-B gradeⅠin 11 cases,gradeⅡin 5,gradeⅢin 2 and gradeⅣin 4. Conclusion Facial neurophysiological monitoring are contributive to preservation of anatomical and functional integrity of facial nerve in microsurgery for large and giant vestibular schwannomas .