弥散张量成像定位在听神经瘤切除术中的应用

Application of diffusion tensor imaging for localization in acoustic neuroma surgery

目的探究弥散张量成像(DTI)定位在听神经瘤切除术中的应用。方法选取2017年1月—2020年1月在西安国际医学中心医院治疗的106例听神经瘤患者,收集患者临床资料。通过术前DTI定位与术中面神经电生理监测结果进行比较,分析两者检测结果的一致性。分析手术效果及术后患者面神经功能。结果面神经均位于肿瘤腹侧,其中位于腹侧中央者最多(44例,占41.51%),其次是腹侧前上部者(25例,占23.58%)。术前DTI结果与术中神经电生理监测结果相符合者有100例(94.34%),不符合者有6例(5.66%),差异无统计学意义(P>0.05)。患者术后面神经均实现解剖保留。术前面神经功能良好率为89.62%;术后2周、3个月、6个月以及1年,患者面神经功能良好率分别为74.53%、46.23%、53.77%及85.85%;患者术前与术后面神经功能分级比较,差异均具有统计学意义(P<0.05)。结论术前通过DTI定位面神经与肿瘤位置较准确,且手术效果较好、面神经保留率较高,术后面神经有一定损伤,6个月后开始恢复,术后面神经功能障碍发生概率降低。

Objective To explore the application of diffusion tensor imaging(DTI)for localization in resecting acoustic neuroma.Methods We collected the clinical data of 106 patients with acoustic neuroma treated in Xi’an International Medical Center Hospital from January 2017 to January 2020.The preoperative DTI localization results and intraoperative electrophysiological monitoring results of the facial nerve were compared for their consistency.The surgical outcome and postoperative facial nerve function were analyzed.Results The facial nerve was located on the ventral side of tumors in all the cases,most frequently at the center of the ventral side(44 cases,41.51%),followed by the anterior superior part of the ventral side(25 cases,23.58%).The preoperative DTI results and the intraoperative electrophysiological monitoring results were consistent in 100 cases(94.34%)and inconsistent in six cases(5.66%),with no significant difference(P>0.05).All the patients achieved anatomical preservation of the facial nerve after surgery.The preoperative percentage of good facial nerve function was 89.62%;at 2 weeks,3 months,6 months,and 1 year after surgery,the percentages of good facial nerve function were 74.53%,46.23%,53.77%,and 85.85%,respectively.The differences in facial nerve function grades before and after surgery were all statistically significant(P<0.05).Conclusions DTI can accurately localize the facial nerve and acoustic neuroma prior to surgery,with good surgical outcome and a high preservation rate of the facial nerve.The facial nerve is damaged to an extent after surgery,which begins to recover after 6 months.The probability of postoperative facial nerve dysfunction is reduced.