乙状窦后入路切除听神经瘤术中神经电生理监测保护面神经的应用

Monitoring and Protection of Intraoperative Electrophysiological Facial Nerve in Sigmoid Sinus Approach for Resection of Acoustic Neuroma

目的探讨乙状窦后入路切除听神经瘤术中神经电生理监测保护面神经的应用方法与效果。方法将88例听神经瘤患者根据随机抽签原则分为治疗组44例与对照组44例。2组都采用显微手术治疗,对照组采用经中颅窝入路,治疗组采用经乙状窦后入路。结果 2组患者均顺利完成手术,2组手术时间、术中出血量及术后住院时间等对比,差异无统计学意义(P>0.05)。术后3个月治疗组后组颅神经功能障碍、耳鸣、泪腺分泌异常、平衡障碍等并发症发生情况明显少于对照组(P<0.05)。与对照组相比,治疗组术后3个月的面神经功能明显较好(P<0.05);治疗组的生活质量评分为(83.44±4.13)分,明显高于对照组的(72.14±4.98)分(P<0.05)。结论显微手术治疗听神经瘤具有很好的微创性,采用乙状窦后入路能有效减少术后并发症的发生,术中神经电生理监测的应用有利于保护患者的面神经功能,从而提高患者的生活质量。

Objective To investigate the monitoring and protection of intraoperative electrophysiological facial nerve in sigmoid sinus approach for resection of acoustic neuroma. Methods 88 acoustic neuroma patients were equally divided into the treatment group and the control group,both groups were used microsurgical surgery,The control group were given the middle cranial fossa approach,and the treatment group were given the sigmoid sinus approach. Results All patients were successfully operated,the operative time,blood loss and postoperative hospital stay between the 2 groups had no statistical difference（ P〈0. 05）.The postoperative 3 months cranial nerve dysfunction,tinnitus,lacrimal gland secretion,balance disorders and other complications in the treatment group were significantly lower than those of the control group（ P〈0. 05）. The postoperative 3 months facial nerve function in the treatment group were significantly better than that of the control group（ P〈0. 05）; the postoperative 3 months quality of life of the treatment group was（ 83. 44 ± 4. 13） points,which were significantly higher than（ 72. 14 ± 4. 98） points in the control group（ P〈0. 05）. Conclusion Microsurgical treatment of acoustic neuroma is minimally invasive,and sigmoid sinus approach can effectively reduce the incidence of postoperative complications,intraoperative neurophysiological monitoring can help protect the facial nerve function in patients,thus improve the quality of life of patients.