术中耳蜗电图监测在脑桥小脑角区胆脂瘤切除术中的应用

Application of intraoperative cochlear electroencephalography monitoring in resection of cholesteatoma in cerebellopontine angle region

目的 分析术中耳蜗电图(ECochG)监测信息与术后美国耳鼻咽喉头颈外科学会(AAO-HNS)听力功能分级及听力残疾量表(HHI)之间的关系。方法 回顾性分析中日友好医院神经外科2019年3月—2022年3月收治的86例脑桥小脑角(CPA)区胆脂瘤患者的临床资料。所有患者均采用乙状窦后入路切除CPA区胆脂瘤,在术中ECochG的监测下完成肿瘤的完整切除。依据术中ECochG监测信息中动作电位(AP)波幅下降>30%与否分为两组,AP波幅下降>30%组和AP波幅下降≤30%组,分析两个组与术后听力功能障碍及听力残疾程度的关系。结果 AP波幅下降>30%组患者术后存在听力功能障碍,并且在随访3个月、1年和2年后,患者的听力功能障碍持续存在,且有统计学差异(P<0.001)。AP波幅下降>30%组患者术后存在不同程度的听力残疾,在随访3个月、1年和2年后,患者的HHI情绪相关(subtotal-E)及社会相关(subtotal-S)的听力残疾持续存在,有统计学差异(P<0.001);HHI subtotal-E及subtotal-S相关的残疾程度会逐渐加重,有统计学差异(P<0.05)。结论 术中AP波幅下降>30%的患者在CPA区胆脂瘤术后存在永久听力障碍,其术后subtotal-E及subtotal-S相关的听力残疾程度会逐渐加重。

Objective To examine the relationship between intraoperative electrocochleography(ECoG) monitoring data and post-operative audiometric grading using American academy of otolaryngology-head and neck surgery(AAO-HNS) scale,as well as hearing handicap inventory(HHI) severity scores for hearing disability.Methods The clinical data of 86 patients with cerebellopontine angle(CPA) cholesteatoma admitted to Department of Neurosurgery,China-Japan Friendship Hospital from March 2019 to March 2022 were analyzed retrospectively.All patients underwent retrosigmoid approach surgery for CPA cholesteatoma removal,with intraoperative ECochG monitoring to ensure complete tumor resection.According to the intraoperative ECochG monitoring information,patients were divided into two groups based on whether the action potential(AP) drops over 30% or not.The AP drops>30% group and the AP drops≤30% group were used to analyze the relationship between the two groups and postoperative hearing impairment and the degree of hearing disability.Results Patients in the AP drops> 30% group exhibited postoperative hearing impairment,and their hearing impairment persisted after 3 months,1 year,and 2 years of follow-up,with statistical differences(P <0.001).Patients with AP drops> 30%had varying degrees of hearing disability after surgery.After follow-up for 3 months,1 year,and 2years,patients' HHI subtotal emotional(subtotal-E) and subtotal situational(subtotal-S) related hearing disabilities persisted,with statistical differences(P <0.001).The degree of disability related to HHI subtotal-E and subtotal-S will gradually worsen,with statistical differences(P <0.05).Conclusions Patients with intraoperative AP drops> 30% have permanent hearing impairment after CPA area cholesteatoma surgery,and their postoperative subtotal-E and subtotal-S related hearing disabilities will gradually worsen.