听神经瘤术中面神经电生理监测的问题与对策  

Problems and solutions of intraoperative facial nerve electrophysiologic monitoring for acoustic neuroma

作　　者：刘晓军[1] 漆松涛[1] 刘文[1] 方陆雄[1] 张国忠[1] 王浩[1] 郭志旺[1] 黄广龙[1] 孟伟[1] 

机构地区：[1]南方医科大学南方医院神经外科,广州510515

出　　处：《中华神经外科杂志》2009年第6期490-493,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨听神经瘤术中面神经电生理监测技术的常见问题与对策，提高面神经解剖保留率，并对解剖保留的面神经进行功能评价。方法25例听神经瘤患者手术时均在面神经电生理监测下进行，全部采用枕下乙状窦后入路，显微外科切除肿瘤，肿瘤切除后对面神经功能进行评价。结果肿瘤全切除25例（100％），无手术死亡；面神经解剖保留23例，占92％。面神经功能状态H—B分级Ⅰ、Ⅱ级19例，Ⅲ、Ⅳ级5例，Ⅴ级1例。术末刺激强度越小，术后面神经功能越好；低于0．5mA同时面肌肌电波幅大于100μV，面神经功能可达Ⅰ～Ⅱ级；术末刺激强度大于2mA波幅反应不明显时，术后面神经功能恢复不理想。结论术中自发或诱发式神经电生理监测技术的灵活应用可明显提高面神经解剖保留率和功能保留率，对其定量分析有助于术后面神经功能的判断。Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboecipital retrosigmoid approaches under microscope in 25 eases. Intraoperative monitoring was used to protect facial nerve and evaluated its funetion. Results Total removal was achieved in 25 patients（ 100% ）. The facial nerve was preserved anatomieally in 23 eases（92%）,H- B Grade Ⅰ - Ⅱin 19 cases, Gradem Ⅲ-Ⅳ in 5, Grade Ⅴ - Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ - Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial eleetromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled teehnique of intraoperative facial nerve electrophysiologie monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of eleetromyogram may help to evaluate its postoperative function.

关 键 词：神经瘤 听 面神经 电生理监测 神经外科手术 

分 类 号：R686[医药卫生—骨科学]