前瞻性队列研究微小电流刺激阈值在听神经瘤术后面神经功能评估中的作用(附96例报告)  

Application of small current perioperative stimulation threshold in evaluation of facial nerve function post acoustic neuroma surgery(report of 96 cases)

作　　者：汪海 黄翔 徐健 徐铭 陈旦麒 陈明宇 钟平 Wang Hai;Huang Xiang;Xu Jian;Xu Ming;Chen Danqi;Chen Mingyu;Zhong Ping(Department of Neurosurgery,Huashan Hospital,Fudan University,Shanghai 200040,China;Shanghai Medical College,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属华山医院神经外科,上海200040 [2]复旦大学上海医学院,上海200032

出　　处：《中华神经外科杂志》2019年第5期443-447,共5页Chinese Journal of Neurosurgery

基　　金：国家星火计划(S2013C000013);上海市科委医学引导类项目(134119a4700);上海市科委"扬帆"计划(15YF1401500).

摘　　要：目的探讨面神经微小电流刺激阈值对听神经瘤切除术后面神经功能的预测作用。方法采用前瞻性队列研究方法,对2013年1月至2015年4月复旦大学附属华山医院神经外科收治的96例听神经瘤患者的临床资料进行分析。所有患者均于肿瘤完全切除后采用四通道肌电图监护仪刺激面神经全长,记录面神经脑干起始段引出动作电位的最小电流,即面神经刺激阈值。根据检测的刺激阈值将患者分为微小电流组(≤0.05mA)和对照组(>0.05mA)。术后1、3、6及12个月,采用House-Brackmann(H-B)分级评估面神经功能。比较两组患者面神经功能的恢复情况,采用线性回归拟合回归曲线分析面神经功能的恢复速度。采用四格表法计算微小电流预测面神经功能的灵敏度和特异度。结果96例听神经瘤患者的面神经刺激阈值为0.01~0.35mA,平均(0.06±0.02)mA;其中微小电流组74例,对照组22例。两组患者的年龄、肿瘤大小、位置、质地、Samii分级及术前H-B分级的差异均无统计学意义(均P>0.05)。术后1、3、6及12个月,微小电流组中预后良好率均显著高于对照组[术后1个月分别为43.2%(32/74)、4.5%(1/22);术后3个月分别为62.2%(46/74)、31.8%(7/22);术后6个月分别为70.3%(52/74)、40.9%(9/22);术后12个月分别为81.1%(60/74)、45.5%(10/22);均P<0.05]。两组术后1个月H-B分级为Ⅳ级的患者,面神经功能恢复速率间的差异有统计学意义(曲线斜率分别为-0.163、-0.057,P=0.004)。微小电流对术后1年面神经功能预测的灵敏度和特异度分别为85.7%和46.2%。结论微小电流刺激阈值能较好地预测听神经瘤术后面神经功能的早期及长期预后;且对于术后1个月H-B分级为Ⅳ级的患者,则预示较快的面神经功能恢复速度。Objective To explore the predictive value of small current stimulation threshold for the facial nerve outcome after acoustic neuroma surgery. Methods Ninety-six acoustic neuroma patients underwent tumor resection by a single team at Department of Neurosurgery, Huashan Hospital, Fudan University from January 2013 to April 2015 and were enrolled into a prospective cohort study. We defined the minimal stimulation intensity of facial nerve proximal to the brainstem to induce action potential after tumor total resection as stimulation threshold (ST) and a ST of ≤ 0.05 mA as small current. Facial nerve function was evaluated using House-Brackmann (H-B) scale preoperatively and postoperatively (1, 3, 6, 12 months). By means of binary, ordinal and linear regression analysis, the facial nerve function outcomes in the small current and control (> 0.05 mA) groups were compared.The sensitivity and specificity of the small current prediction facial nerve function were calculated by the four-grid method. Results The ST in all 96 cases was 0.01-0.35 mA with an average of 0.06±0.02 mA. Seventy-four patients were included in the small current group and 22 in the control group. While adjusting for the following covariates: ages, tumor size, tumor location, tumor texture, Samii scale and preoperative H-B scale, binary logistic regression analysis showed that the rate of good facial nerve outcome (H-B score of Ⅰ-Ⅱ) in small current group was significantly better than that in control group [43.2%(32/74) vs. 4.5%(1/22) at 1 month;62.2%(46/74) vs. 31.8%(7/22) at 3 months;70.3%(52/74) vs. 40.9%(9/22) at 6 months;81.1%(60/74)vs. 45.5%(10/22) at 12 months;all P<0.05]. Ordinal regression analysis revealed that compared with the control group the facial nerve outcome in small current group shifted toward a better condition at 1, 3, 6, and 12 months postoperatively. A faster recovery rate was found in small current group among patients with H-B score of Ⅳ at 1 month postoperatively (slope:-0.163 vs.-0.057, P=0.004). The sensitivity

关 键 词：神经瘤 听 面神经 微小电流 预后 

分 类 号：R739.4[医药卫生—肿瘤]