弥散张量面神经成像技术在大型听神经瘤术中面神经定位的可行性研究  

Feasibility of preoperative facial nerve visualization and localization by diffusion tensor imaging in large vestibular schwannoma surgery

作　　者：刘宏毅[1] 张玉海[1] 邹元杰[1] 刘翔[1] 章文斌[1] 张锐[1] 陈永严[1] 黄庆玖[1] 肖朝勇[2] 刘文[2] 

机构地区：[1]南京医科大学附属脑科医院神经外科,210029 [2]南京医科大学附属脑科医院影像科,210029

出　　处：《临床神经外科杂志》2015年第1期36-39,共4页Journal of Clinical Neurosurgery

摘　　要：目的探索术前运用弥散张量成像（DTI）技术定位大型听神经瘤与面神经相对位置的可行性,为术中保护和术后改善面神经功能提供帮助。方法对23例直径≥3.0 cm的大型听神经瘤病例,术前采用DTI显示肿瘤侧面神经并定位面神经与肿瘤的相对位置关系,在术中通过观察和电生理监测,验证术前面神经影像定位的准确性,并采取措施保护,术后随访面神经功能。结果肿瘤直径3.0-6.0 cm,平均（3.8±0.8）cm;18例（78.3%）面神经可通过DTI显示,其中8例面神经位于肿瘤腹侧中部,6例位于肿瘤腹侧下方,2例位于肿瘤腹侧上方,1例位于肿瘤上极,1例位于肿瘤下极。术前DTI定位与术中定位吻合率为100%。1例直径5.0 cm听神经瘤的面神经仅部分显示,3例术前面瘫者和1例囊性听神经瘤的面神经未显示。肿瘤全切除19例,次全切除4例。术后随访4-28个月,面神经功能HBⅠ级10例,HBⅡ级13例。结论 DTI面神经成像技术有助于术前定位大型听神经瘤中的面神经位置,提高面神经的解剖和功能保留率,是降低大型听神经瘤手术后面神经功能障碍的有效技术。Objective To explore the feasibility of preoperative visualization and localization of facial nerve by diffusion tensor imaging （ DTI ） in large vestibular schwannoma for facial nerve sparing.Methods 23 patients with unilateral vestibular schwannoma （ extrameatal diameter≥3.0 cm） were included in this study .Visualization and identification of facial nerves with DTI were performed in each case preoperatively , and the results were validated by intraoperative inspecting and electrophysiological monitoring .Functional outcome of the cases were followed up periodically . Results The diameter of the tumors was 3.0-6.0 cm（ mean 3.8 cm ）.Facial nerve identification by DTI were successful in 18 cases（78.3%）, among whom, 8 were anterior to the tumor , 6 were anteroinferior to the tumor , 2 were anterosuperior to the tumor , 1 was on the superior pole and 1 was on the inferior pole .The results corresponded to intraoperative findings in each case .Only partial facial nerve could be shown in 1 case with a large cystic VS , and facial nerve could not be visualized in 3 with preoperative facial paralysis and 1 with the tumor diameter of 5.0 cm.Gross total resection of the tumor were achieved in 19 cases, and subtotal resection in the other 4 cases.Facial nerve function was House-Brackmann grade Ⅰin 10 cases and grade Ⅱin 13 cases.Conclusions DTI is an effective technique that contributes to preoperatively localizing and improving anatomical and functional preservation of facial nerve in large vestibular schwannoma surgery .

关 键 词：听神经瘤 面神经 弥散张量成像 电生理监测 显微手术 

分 类 号：R764[医药卫生—耳鼻咽喉科]