多模态面神经联合监测在大型听神经瘤手术中的应用  

Application of multi-mode intraoperative monitoring of facial nerve structure and function preservation during giant vestibular schwannomas surgery:A retrospective study

作　　者：蒋伟超 陈曦[1] 杨晓翠[2] 林立慧 朱治 陈四方[1] 谭国伟[1] Jiang Weichao;Chen Xi;Yang Xiaocui;Lin Lihui;Zhu Zhi;Chen Sifang;Tan Guowei(Department of Neurosurgery,the First Affiliated Hospital of Xiamen University,Xiamen 361003,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Pharmacy,Zhangzhou Affiliated Hospital of Fujian Medical University,Zhangzhou 363000,China)

机构地区：[1]厦门大学附属第一医院神经外科,厦门361003 [2]首都医科大学,北京市神经外科研究所,100070 [3]福建医科大学附属漳州市医院药学部,漳州363000

出　　处：《中华神经外科杂志》2019年第5期480-484,共5页Chinese Journal of Neurosurgery

基　　金：福建省自然科学基金(2018J01380).

摘　　要：目的探讨多模态面神经联合监测在大型听神经瘤手术中的应用价值。方法回顾性纳入厦门大学附属第一医院神经外科2016年12月至2018年1月行手术治疗的28例大型听神经瘤(肿瘤直径≥3 cm)患者,术中采用多模态面神经联合监测(设为监测组);纳入2013年3月至2016年11月术中未行多模态面神经联合监测的30例大型听神经瘤患者为对照组。比较两组的一般资料(包括年龄、性别、肿瘤的大小、肿瘤的囊实性、肿瘤所在侧别)、手术时长、术后面神经解剖和功能(采用House-Brackmann分级进行评估)保留情况,以及术后并发症情况。结果两组一般资料的差异无统计学意义(均P>0.05)。监测组的平均手术时长为(413.4±166.1)min,对照组为(499.7±159.6)min,两组的差异有统计学意义(t=-2.02,P=0.048)。监测组28例肿瘤均全切除;对照组全切除28例,次全切除2例,两组全切除率的差异无统计学意义(P=0.490)。监测组和对照组的面神经解剖保留率分别为100.0%(28/28)和90.0%(27/30),两组的差异无统计学意义(P=0.240)。比较两组术后1周、3个月的面神经House-Brackmann分级较术前的变化情况,结果显示,监测组的面神经功能保留情况均好于对照组(术后1周:P=0.043,术后3个月:P=0.039)。监测组的术后并发症发生率低于对照组(14.3%对比40.0%,P=0.029)。结论在大型听神经瘤手术中,熟练应用多模态面神经联合监测能够有效缩短手术时长,提高面神经功能的保留率,减少术后并发症的发生。Objectives To explore the application value of intraoperative multi-mode facial nerve monitoring during resection of giant vestibular schwannomas and to provide evidence for further technical and surgical refinements. Methods A total of 58 patients with giant vestibular schwannomas (tumor diameter≥3 cm) underwent microsurgical resection at Department of Neurosurgery, the First Affiliated Hospital of Xiamen University and were retrospectively analyzed in this study. From December 2016 to January 2018, 28 cases who received multi-mode intraoperative monitoring were set as monitoring group. From March 2013 to November 2016, 30 cases without multi-mode intraoperative monitoring were set as control group. The baseline data (age, sex, size of tumor, cystic-solid quality of tumor, side of tumor), operational duration, surgical resection rate, anatomical and function preservation (evaluated based on House-Brackmann grade) of facial nerves and postoperative complication were compared between the 2 groups. Results The operational duration was obviously shorter in monitoring group (413.4±166.1 min) with statistical difference (t=-2.02, P=0.048) compared to that in control group (499.7±159.6 min). Total resection rate in monitoring group was 100.0%(28/28) and that in control group was 93.3%(28/30). Anatomical preservation rate in monitoring group was 100.0%(28/28) while that in control group was 90.0%(27/30). There was no significant difference in total resection rate or anatomical preservation rate between the 2 groups(both P>0.05). Significantly higher function preservation rate of facial nerves was observed in monitoring group than in control group at 1 week (P=0.043) and 3 months (P=0.039) post surgery. The incidence rate of complication was lower (P=0.029) in monitoring group (14.3%) than in control group(40.0%). Conclusion Intraoperative multi-mode facial nerve monitoring could help shorten the operation duration, increase the function preservation rate of the facial nerves and reduce the clinical postoperative com

关 键 词：神经瘤 听 神经外科手术 面神经 术中神经电生理监测 

分 类 号：R739.4[医药卫生—肿瘤]