弥散张量成像(DTI)联合内镜技术在听神经瘤切除术中的面神经保护作用

Diffusion Tensor Imaging(DTI) and Endoscopy in Acoustic Neuroma Surgery for Facial Nerve Protection

目的在听神经瘤手术中,术前采用弥散张量成像(Diffusion Tensor Imaging,DTI)纤维束追踪技术及术中内窥镜辅助的方法,以提高面神经功能的保存几率。方法 2016年1月至2017年7月在中山大学孙逸仙纪念医院耳鼻喉科收治的单侧听神经瘤患者22例,均行迷路进路听神经瘤切除手术,术前应用DTI技术重建了解面神经走行及其与肿瘤的关系,术中在内窥镜辅助下,在预判的区域使用面神经监测仪识别出面神经,并对之进行针对性地保护,术后影像学评估肿瘤切除程度及评估面神经功能。结果 22例患者的面神经均可通过DTI技术显示,术中验证面神经位置与术前定位吻合率100%。22例患者,按肿瘤最大直径分期:Ⅱ期9例,Ⅲ期11例,Ⅳ期2例;肿瘤全切除者18例(81.8%),近全切除者3例(13.6%),次全切除1例(4.6%)。术后2周面神经功能评估:Ⅳ级1例,Ⅲ级2例,Ⅱ级5例,I级14例;术后3个月面神经功能评估:Ⅲ级1例,Ⅱ级2例,I级19例。结论在听神经瘤手术中,采用术前DTI技术及术中内窥镜辅助的方法,可有效保护面神经功能。

Objective To report utility of pre-operative,diffusion tensor imaging(DTI)fiber tracking and intraoperative endoscopy in acoustic neuroma surgery to improve preservation of facial nerve function.Methods From January 2016 to July 2017,22 patients with unilateral acoustic neuromas were treated at the Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University.They all had acoustic neuromas resection by translabyrinthine approach.Preoperative DTI technique was used to reconstruct the facial nerve and its relationship with the tumor.With the help of endoscopy,the facial nerve was identified using a facial nerve monitor in the predicted area during surgery,and targeted protection was provided.After operation,we evaluated the completeness of tumor resection by imaging as well as facial nerve function.Results In all 22 patients(100%),facial nerve positions reconstructed and predicted by DTI matched the actual position in surgery.By the maximum diameter,the tumor was stageⅡin 9 cases,stageⅢin 11 cases and stageⅣin 2 cases.Total tumor resection was achieved in 18 cases(81.8%),near total in 3 cases(13.6%),and subtotal in 1 case(4.6%).Facial nerve function at 2 weeks after operation was gradeⅣin 1 case,gradeⅢin 2 cases,gradeⅡin 5 cases and grade I in 14 cases.Facial nerve function at 3 months after operation was gradeⅢin 1 case,gradeⅡin 2 cases and gradeⅠin 19 cases.Conclusion In acoustic neuroma surgery,preoperative DTI and intraoperative endoscopy can effectively improve the preservation of facial nerve function.