TOF联合面神经运动诱发电位在听神经鞘瘤术中的应用体会

Application of TOF combined with facial nerve motor evoked potential in acoustic schwannoma

目的为了降低肌松药物对听神经鞘瘤术中面神经运动诱发电位(FNMEP)敏感性的影响,采用四成串刺激(TOF)监测实时判断术中肌松药物的代谢情况.方法应用凯威16通道术中神经电生理监测仪,将我院2020年5—11月采用TOF联合常规术中神经电生理监测对显微神经外科手术治疗的12例听神经鞘瘤患者进行实时FNMEP监测.结果12例患者术中均在TOF值(T4/T1)≥50%的情况下实施常规术中神经电生理监测及FNMEP监测.术后随访5~6个月,其中大部分患者的面神经功能较术后2周均有所恢复,其中Ⅰ级3例(25%),Ⅱ级6例(50%),Ⅲ级2例(17%),Ⅳ级1例(8%),无死亡病例.结论在TOF值≥50%的情况下实施FNMEP监测可能有助于提高术中FNMEP的敏感性及面神经保留率.

Objective In order to reduce the effect of muscle relaxant on the sensitivity of facial motor evoked potential(FNMEP)during operation of acoustic schwannoma,train of four stimulation(train of four stimulation,TOF)monitoring were used to judge the metabolism of muscle relaxant drugs in real time.Methods Using Cadwell 16 channel intraoperative neuroelectrophysiological monitor,the TOF combined with routine intraoperative neuroelectrophysiological monitoring was used in our hospital from May 2020 to November 2020 to monitor the real-time FNMEP of 12 patients with acoustic neurilemmoma treated by microsurgery.Results All 12 patients were followed up after operation,routine intraoperative neuroelectrophysiological monitoring and FNMEP monitoring were performed when TOF(T4/T1)were greater than or equal to 50%.Follow-up period was 5 to 6 months.Most of the patients recovered their facial nerve function from 2 weeks after surgery,among them there were 3 cases of gradeⅠ(25%),6 cases of gradeⅡ(50%),2 cases of gradeⅢ(17%),1 case of gradeⅣ(8%),none cases ofⅤ,Ⅵ,and deaths.Conclusions The implementation of FNMEP monitoring at a TOF value of more than or equal to 50%may help to improve the sensitivity of intraoperative FNMEP and improve the facial nerve retention rate.