术中运动神经监测在颈部神经源性肿瘤手术中的应用价值

Intraoperative neuromonitoring in surgery of cervical neurogenic tumors

目的探讨术中运动神经监测在颈部神经源性肿瘤手术中的应用价值。方法回顾性分析2019年6月至2022年9月,在南京大学医学院附属鼓楼医院就诊并在术中运动神经监测下行颈部神经源性肿瘤囊内全切除的18例病例资料,男性6例,女性12例,年龄15~74岁。分析术中及术后结果,探讨术中运动神经监测在其手术过程中的应用价值。结果 18例患者肿瘤均行囊内全切除,其中8例起源于迷走神经,10例起源于臂丛神经。臂丛神经起源患者术后运动神经功能均正常,迷走神经起源患者有2例术后出现声带发声代偿性恢复的不完全性麻痹,最终运动神经损伤率为11.1%(2/18)。术后随访6~45个月,未见肿瘤复发。结论术中运动神经监测对颈部神经源性肿瘤手术有重要应用价值,有望在保护神经功能的基础上彻底切除肿瘤。

Objective To investigate the application value of intraoperative motor nerve monitoring in cervical neurogenic tumor surgery.Methods The efficacy of intraoperative neuromonitoring(IONM)was analyzed retrospectively in 18 patients,including 6 males and 12 females,aged from 15 to 74 years,treated in Affiliated Drum Tower Hospital,Medical School of Nanjing University from June 2019 to September 2022 who underwent total cystectomy of cervical neurogenic tumors under intraoperative nerve monitoring.Results All 18 patients had complete tumor removal,including 8 patients with tumors from the vagus nerve and 10 patients with tumors from the brachial plexus nerve.Postoperative nerve functions were normal in patients with tumors from brachial plexus nerve,and incomplete vocal cord paralysis occurred in 2 patients with tumors from vagus vagus nerve.The total incidence of motor nerve injury was 11.1%(2/18).All patients were followed up for 6 to 45 months,with no tumor recurrence.Conclusion Intraoperative neuromonitoring has significant values in surgery of cervical neurogenic tumors,which is helpful to remove completely the tumors on the basis of protecting the nerve functions to the maximum extent.