神经电生理监测在听神经瘤切除术中的应用  

Neurophysiological monitoring in microsurgical treatment of vestibular schwannomas

作　　者：陈立华[1] 赵浩[1] 魏群[1] 李运军[1] 李文德[1] 高进宝[1] 张鹏飞[1] 于斌[1] 徐如祥[1] 

机构地区：[1]北京军区总医院附属八一脑科医院,北京100700

出　　处：《中华神经医学杂志》2014年第4期379-382,共4页Chinese Journal of Neuromedicine

摘　　要：目的总结微侵袭方法处理听神经瘤的经验，探讨面、听神经保护的显微外科技巧，提高肿瘤的全切除率和面、听神经的保护率。方法北京军区总医院附属八一脑科医院自2006年1月至2012年1月采用乙状窦后一内听道人路显微外科切除术治疗听神经瘤患者293例，其中287例患者术中进行神经电生理监测定位面、听神经并确定神经的完整性。31例患者采用术中神经导航定位静脉窦，引导内听道后壁的磨除。回顾性分析患者的临床资料及疗效。结果本组肿瘤全切除289例（98．6％），次全切除4例；术中解剖保留面神经278例（94．9％1，解剖未能保留的9例，术中8例行面神经端一端吻合，1例行副神经移植。肿瘤切除3个月后复查面神经功能显示House．Brackmann面神经功能分级Ⅰ～Ⅱ级247例（84．3％），Ⅲ-Ⅳ级33例（15．7％1，Ⅴ级7例；术前尚存有效听力的33例患者，术后9例保留有效的听力（27.3％）；无手术相关死亡病例。结论术中神经电生理监测的应用有助于提高听神经瘤切除的安全性、微创性和手术疗效，以及面、听神经解剖和功能保护率。Objective To summarize the experience of acoustic neuroma removal in a minimal invasive method, and explore the technique of facial and auditory nerve preservation in microsurgery in order to improve tumor removal rate and nerve preservation rate. Methods Two hundred and ninety-three patients suffering from acoustic neuromas treated microsurgically by suboccipital retrosigmoid transmeatus approach under neurophysiological monitoring or intraoperative navigation assistance in our hospital from January 2006 to January 2012, were chosen in our study. Neurophysiological monitoring was used in 287 patients to locate the position of facial nerve and auditory nerve, and intraoperative navigation assistance was chosen in 31 patients to locate the position of sinus and guide the removal of the posterior wall of the internal auditory meatus （IAM）; their clinical data and treatment efficacy were analyzed retrospectively. Results Total resection of the tumors was achieved in 289 patients （98.6%）. Facial nerve was preserved in 278 patients （94.9%） in anatomy. Three months after tumor resection, facial nerve function was preserved （Grade Ⅰ andⅡ by House-Brackmann facial nerve function scale） in 247 patients （84.3%）; 33 patients （15.7%） was graded into Ⅲ-Ⅳ. Audition was preserved in 33 patients before the resection and 9 （27.3%） after the resection. No patient died in this series. Conclusion The application of neurophysiological monitoring in the microsurgical treatment will be helpful to ensure the safe removal, decrease invasive injure and improve the surgical outcome of acoustic neuromas; it also helps keep facial nerve anatomic intact and improve functional preservation.

关 键 词：听神经瘤 面神经 神经导航 神经监测 显微外科技术 

分 类 号：R739.41[医药卫生—肿瘤]