中华耳科学杂志

目的探讨听神经瘤术中监测面肌自发与诱发肌电图和听觉诱发电位的经验,分析术中面、听神经解剖功能保留的方法及评估电刺激强度和术后面神经功能的相关性及其安全性。方法回顾性分析我科从2001年10月到2012年10月,共对610例听神经瘤患者进行了术中监测面肌自发与诱发肌电图和听觉诱发电位。结果通过诱发肌电图及BAEP的监测,肿瘤的全切率为96.05%,面神经解剖保留率为95.39%,功能保留率(H-B分级I-II级)91.61%,术末面神经直接刺激脑干端1~3V即引起肌电反应者,神经保留完整,预后良好。57例肿瘤直径<3cm患者中,听神经解剖保留率70.18%,保留有用听力(功能保留率)31.58%。结论术中面肌自发与诱发肌电图和听觉诱发电位监测,提高了肿瘤的全切率和面听神经保留率,并可以减少或防止脑干功能的损伤。

Objective To report the authors’ experiences with intraoperative muscles spontaneous and evoked facial electromyogram and brainstem auditory evoked potential monitoring in relation to facial and acoustic nerves functional preservation during acoustic neuroma resection. Methods Between October 2001 and October 2012, 610 patients with acoustic neuromas underwent surgical resection with intraoperative facial electromyogram and brainstem auditory evoked potential monitoring. Results The rate of total tumor resection was 96.05%. With evoked electromyogram and brainstem auditory evoked potential monitoring, the facial nerve was anatomically intact in 95.39% of the patients with function preservation (H-B Grade I-II) in 91.61% of the patients. Successful induction of facial electromyogram at 1-3V after tumor resection was correlated to satisfactory postoperative facial nerve function. The acoustic nerve was anatomically intact in 70.18% of the 57 patients with small acoustic neuromas (< 3 cm) with useful postoperative hearing in 31.58%. Conclusion Intraoperative facial electromyogram and brainstem auditory evoked potential monitoring are beneficial to improve the rate of total tumor removal and facial nerve preservation. Intraoperative neurophysiologic monitoring can also help reduce the chance of brainstem injury.