神经电生理监测在臂丛神经鞘瘤显微切除术的应用

Application of electrophysiological monitoring of neurons in microsurgical resection of brachial neurilemmoma

目的探讨神经电生理监测在臂丛神经鞘瘤显微切除术的应用。方法回顾性分析10例臂丛神经鞘瘤,其中臂丛上干5例,中干3例,外侧束1例,C_(5~6)神经根1例。均在神经电生理监测下行显微手术切除肿瘤。结果肿瘤全切除9例,大部切除1例,术后病理证实均为神经鞘瘤。症状术后即刻缓解7例,术后3个月内缓解2例。1例巨大臂丛肿瘤病例术后出现肩关节上抬无力,术后6个月肌力恢复正常。本组病例均随访3~18个月,未见肿瘤复发。结论在臂丛神经鞘瘤显微切除术中应用神经电生理监测,能最大程度识别并保护神经纤维,减少医源性损伤,在最大限度保留神经功能基础上彻底切除肿瘤。

Objective To investigate the application of intraoperative neurophysiological monitoring in microsurgery for brachial plexus neurilemmoma. Methods The clinical data of 10 patients with brachial plexus neurilemmoma were analyzed retrospectively. Tumor involving the upper trunk of the nerve was seen in 5 patients, middle trunk in 3, lateral branch in 1 patient and C5～6nerve root in 1. All the microsurgeries were performed under the electrophysiological monitoring. Results Total tumor resection was achieved in 9 cases and subtotal in 1 case. The postoperative pathology confirmed neurilemmoma in 10 cases. Seven patients got relief of the symptoms after operation, 2 relieved within 3 months after operation and 1 patient with giant brachial plexus tumor produced postoperative shoulder weakness, returned to normal after 6 months. During the follow-up period ranging from 3 to 18 months, no recurrence of the tumor was found. Conclusions The application of intraoperative neurophysiological monitoring in microsurgery for brachial plexus neurilemmoma can help to identify and protect the nerve fibers to the great degree, reduce the iatrogenic injury and completely resect the tumor on the basis of preserving the nerve function to the maximum degree.