电生理监测在听神经瘤手术中的应用分析

Analysis of intraoperative electrophysiological monitoring of facial nerve during acoustic neuromas surgery

目的探讨听神经瘤术中行电生理监测的方法及意义。方法回顾性分析中国医科大学附属第一医院神经外科2010年7月-2012年6月完成的144例听神经瘤手术患者的临床资料,其中单纯显微手术切除75例(未监测组),电生理监测下显微手术切除69例(监测组);评价患者术前、术后面神经的功能状态,并比较两组病例肿瘤切除程度和面神经功能保留情况。结果未监测组全切率81.33%(61/75),术后面神经保留率为69.30%;监测组全切率86.96%(60/69),术后面神经保留率为91.30%。面神经的功能保留与瘤体大小有直接关系,直径越大的肿瘤越难保留。结论显微手术与术中电生理监测的结合应用是听神经瘤全切并保留面神经的关键;手术中进行面神经电生理监测为提高面神经解剖和功能保留率提供了有效的帮助,具有较高的准确性和实用性。

[ Objective ] To analyze the methods and the signifieance of intraoperative eleetrophysiological moni- toring during acoustic neuromas surgery. [Methods~ We reported 144 acoustic neuromas in which 75 cases under- went mierosurgical excision directly （non-monitoring group）, and 69 cases underwent mierosurgical removal with in- traoperative electrophysiological monitoring （monitoring group） between July 2010 and June 2012 in our department. The function and retention of patients＂ facial nerves as well as the extent of resection between 2 groups were evalu- ated and compared, respectively. [Results] In non-monitoring group, gross total resection was achieved in 61/75 cases （81.33%）, and facial nerve was preserved in 52/75 eases（69.30%）. In monitoring group, 60/69 cases（86.96%） obtained gross total resection and 91.30% （63/69） eases gained facial nerve preservation. The functional preservation of facial nerve was directly related to the diameter of tumor. The larger the tumor is, the more difficult to preserve facial nerve. [Conclusions] Microsurgery and application of intraoperative electrophysiologica] monitoring are the keys to completely resect acoustic neuroma and preserve the facial nerve anatomically and functionally. Intraopera- tive electrophysiological monitoring provides effective assistance to improve the retention rate of facial nerve either in anatomy or in function, which is statistically accurate and practical.