神经电生理监测在听神经鞘瘤切除术中的应用分析

Application of electrophysiological monitoring in acoustic neuroma resection

目的:探究面神经监测在听神经鞘瘤切除术的神经保护作用及其对预后的影响。方法:对苏州大学附属第一医院神经外科近2年来入院的80例听神经鞘瘤患者进行了前瞻性观察。将入院患者数字随机分为监测组和非监测组,测量患者肿瘤大小,对患者一般情况进行统计,评估患者术前听力下降情况,是否存在面部麻木,听神经鞘瘤后组相关症状,面神经功能等级等表现。监测组在实施听神经鞘瘤切除术时进行面神经监测,非监测组在手术过程中不进行监测,两组患者均根据术中实际情况决定行全切或次全切术。术后3 d再次评估其听力情况,面部麻木,后组相关症状及面神经功能等级,同时于术后1个月评估其预后格拉斯哥结局评分(GOS)。结果:两组患者一般情况及术前评估均未见显著差异,手术方式差异无统计学意义。术后监测组面部麻木发生率为42.9%(15/35),明显低于未检测组86.7%(39/45)(P<0.001);面神经功能分级监测组Ⅰ级(17例)、Ⅱ级(9例),Ⅲ级(8例),Ⅳ级(1例);较未检测组[Ⅰ级(1例)、Ⅱ级(18例),Ⅲ级(17例),Ⅳ级(9例)]显著降低(P<0.001);预后GOS(4.60±0.55)较未检测组(3.78±0.67)显著提高,差异均有统计学意义(P<0.001)。结论:面神经监测在听神经鞘瘤切除手术中能够提供较好的神经保护作用,避免面听神经损伤,显著提高患者预后生活质量。

Objective To investigate the neuroprotective effect of facial nerve monitoring on acoustic schwannoma resection and its impact on prognosis.Methods Eighty patients with acoustic schwannomas were enrolled in our study in the past 2 years and randomly divided into a monitoring group and a non-monitoring group.Tumor size was measured by MRI,and the general condition of the patients were analyzed.The preoperative hearing loss was evaluated,and the facial numbness,post-group related symptoms,and facial paralysis grade were also evaluated before surgery.The monitoring group performed facial nerve monitoring during the operation of auditory schwannomas resection,while the non-monitoring group did not.Both groups decided to perform total or subtotal resection according to the actual conditions during the operation.The hearing status,facial numbness,posterior group related symptoms and facial paralysis grade were evaluated 3 days after surgery,and the prognosis Glasgow outcome score(GOS)was evaluated 1 month after surgery.Results There were no significant differences between two groups in terms of general condition and preoperative evaluation.There was also no significant difference in surgical methods.But the incidence of facial numbness in monitoring group(42.9%,15/35)was significantly lower than that in non-monitoring group(86.7%,39/45)(P<0.001).The facial paralysis grade in monitoring group(17/Ⅰ,9/Ⅱ,8/Ⅲ,1/Ⅳ)was also significantly lower than that of non-monitoring group(1/Ⅰ,18/Ⅱ,17/Ⅲ,9/Ⅳ)(P<0.001).The prognostic score(GOS)in monitoring group(4.60±0.55)was significantly higher than that in non-monitoring group(3.78±0.67)(P<0.001).Conclusion Facial nerve monitoring can provide better neuroprotection on acoustic schwannoma resection,avoid facial nerve injury,and improve the prognosis quality of life significantly.