神经电生理监测在颞下经岩前入路切除岩斜区肿瘤手术中的临床应用

The application of neuroelectrophysiological monitoring in microsurgery of petroclival tumors via subtemporal anterior transpetrosal approach

目的 探讨术中神经电生理监测辅助颞下经岩前入路切除岩斜区肿瘤的安全性和有效性.方法 回顾性分析2010年6月至2016年4月中国科技大学附属安徽省立医院神经外科收治的64例中、上岩斜区肿瘤（包括脑膜瘤56例,三叉神经鞘瘤8例）患者的临床资料.采取颞下经岩前入路切除岩斜区肿瘤,术中神经电生理监测辅助保护脑神经以及脑干功能.结果 64例患者中,肿瘤全切除41例（64.1％）,次全切除19例（29.7％）,大部分切除4例（6.2％）.术后新增脑神经功能障碍12例（18.8％）,颞叶迟发性血肿2例（3.1％）,颅内感染3例（4.7％）,死亡2例（3.1％）.患侧术前脑干听觉诱发电位Ⅰ、Ⅲ、Ⅴ波潜伏期分别为（1.86±0.24） ms、（4.17 ±0.40） ms和（6.17±0.45） ms;健侧分别为（1.73±0.09）ms、（3.85 ±0.15）ms和（5.80±0.16）ms,两两比较,患侧各波潜伏期均显著长于健侧（均P＜0.05）;患侧术后各波潜伏期分别为（1.79±0.14）ms、（4.04±0.27）ms和（5.94±0.72）ms,较术前各波潜伏期显著缩短（均P＜0.05）.结论 术中神经电生理监测辅助颞下经岩前入路对脑神经的显露、功能异常的早期发现以及脑干功能的监测和保护具有很大帮助.

Objective To investigate the safety and efficacy of intraoperative neuroelectrophysiological monitoring in microsurgery of subtemporal anterior transpetrosal approach to petroclival tumors.Methods A total of 64 patients with petroclival tumors （meningioma,n =56;trigeminal schwannoma,n =8） underwent surgical treatment with intraoperative neuroelectrophysiological monitoring via subtemporal anterior transpetrosal approach from June 2010 to April 2016 at Department of Neurosurgery,the First Affiliated Hospital of University of Science and Technology of China（Anhui Provincial Hospital）.Results Total resection was achieved in 41 （64.1%） cases,subtotal resection in 19 （29.7%） and partial resection in 4 （6.2%） cases.Postoperative complications included neurological dysfunction （18.8%,n =12）,temporal lobe hematoma （3.1%,n =2）,intracranial infection （4.7%,n =3） and 2 （3.1%） died.Preoperative latencies of brain auditory evoked potential （BAEP） Ⅰ,Ⅲ and Ⅴ waves on affected side [（1.86±0.24） ms,（4.17 ±0.40） ms,（6.17 ±0.45） ms,respectively] were longer those of contralateral side [（1.73 ±0.09） ms,（3.85 ±0.15） ms,（5.80 ±0.16） ms,respectively] （all P 〈0.05）.Postoperative latency of BAEP Ⅰ,Ⅲ and Ⅴ waves on affected side [（1.79 ±0.14） ms,（4.04 ±0.27） ms,（5.94 ± 0.72） ms,respectively] were shorter than those prior to operation （all P 〈 0.05）.Conclusion The application of neuroelectrophysiological monitoring in microsurgery of petroclival tumors via subtemporal anterior transpetrosal approach may provide an early detection of cranial nerve dysfunction and better protection of brain stem function.