听觉监护在桥小脑角手术中的应用  

Intraoperative auditory monitoring in cerebellopontine angle surgery

作　　者：贾欢[1] 吴皓[1] 李蕴[1] 王文昊[1] 黄琦[1] 陈向平[1] 

机构地区：[1]上海交通大学医学院新华医院耳鼻咽喉-头颈外科,上海200092

出　　处：《上海交通大学学报（医学版）》2007年第1期57-59,共3页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市卫生局基金(0204084)~~

摘　　要：目的探讨桥小脑角(CPA)手术中应用听觉监测(IAM)的意义。方法在26例桥小脑角手术中,采用听性脑干反应(ABR)和蜗神经动作电位(CNAP)进行听觉监护,患者术前均有听力且ABR能引出。6例(23.1%)行保留听力的听神经瘤摘除术,14例(53.8%)行三叉神经感觉根部分切断术,3例(11.5%)行前庭神经切断术,3例(11.5%)行桥小脑角占位摘除术。结果ABR监护26例,2例(7.7%)监护失败,3例(11.5%)听神经瘤患者出现永久性潜伏期消失,21例(80.8%)成功全程监护并保留术后听力,15例(57.7%)联合ABR和CNAP进行监护。10例(38.5%)患者由于术中听觉潜伏期延长,采用罂粟碱干预,其中7例(70.0%)波形恢复。结论术中听觉监护能有效协助手术,了解听觉通路的状况,CNAP更能定位蜗神经;使用罂粟碱进行干预,能部分恢复术中延长的ABR V波潜伏期,减少术中听觉损伤,降低术后听力下降的发生率;术中应联合应用ABR和CNAP。Objective To explore the significance of intraoperative auditory monitoring （ IAM ） in the cerebellopontine angle （ CPA ） surgery. Methods Auditory brainstem response （ABR） and cochlear nerve action potential （CNAP） were used to monitor the auditory function intraoperatively in 26 patients with a variety of CPA lesions. Serviceable hearing existed and waves of ABR were well evoked in all patients. Six patients （23.1%） were performed acoustic neuroma removal with hearing preservation, 14 （53.8%） partial trigeminal rhizotomy, 3 （11.5%） vestibular neurotomy, and 3 （ 11.5% ） CPA mass removal. Results The auditory function of 26 patients was monitored by ABR. During the surgeries, IAMs were successfully performed in 21 patients （80.8%） with their hearing preserved, but failed in 2 patients （7.7%） , and absence of ABR was presented in 3 acoustic neuromas （ 11.5% ）. Fifteen patients were monitored by both ABR and CNAP. Because of the latency delay, papaverine was used in ten patients, among whom 7 were successfully recovered. Conclusion Surgeries involving CPA can benefit from IAM. The cochlear nerve can be orientated by CNAP. Papaverine can be used to partially recover the latency delay of wave V, mitigate the hearing damage, and reduce the incidence of postoperative hearing loss. ABR and CNAP should be used together in IAM.

关 键 词：桥小脑角 听力 监护 

分 类 号：R651.1[医药卫生—外科学]