面神经运动诱发电位监测在桥脑小脑角区占位切除术中对面神经的保护作用  

Protecting role of facial nerve motor evoked potential monitoring in facial nerves during resection of cerebellopontine angle lesions

作　　者：洪健[1] 韩璐[2] 陈步东[1] 姚鑫[1] 杨玉山[1] Hong Jian;Han Lu;Chen Budong;Yao Xin;Yang Yushan(Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Electrophysiology,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院神经外科,300350 [2]天津市环湖医院神经电生理室,300350

出　　处：《中华神经医学杂志》2020年第4期371-375,共5页Chinese Journal of Neuromedicine

基　　金：天津市卫生行业重点攻关项目(16KG162)。

摘　　要：目的探讨面神经运动诱发电位(FNMEP)监测技术在桥脑小脑角区占位切除术中对面神经的保护作用。方法回顾性分析天津市环湖医院神经外科自2019年1月至12月应用术中FNMEP监测技术行面神经功能监测的83例桥脑小脑角区占位患者的临床资料与监测数据,对比分析术后/术前FNMEP波幅比与术后早期(术后3 d)面神经功能分级之间的关系。结果83例患者中肿瘤全切75例(90.4%)、次全切8例(9.6%)。术中面神经解剖保留率为100%,术后迟发出血死亡1例(1.2%)。术后3 d,面神经House-Brackmann(H-B)分级Ⅰ~Ⅱ级患者62例,术后/术前FNMEP波幅比为85.3%(66.8%,93.4%);H-B分级Ⅲ级患者11例,术后/术前FNMEP波幅比为45.6%(38.7%,43.8%);H-B分级Ⅳ级患者7例,术后/术前FNMEP波幅比为23.1%(16.4%,25.6%);H-B分级Ⅴ~Ⅵ级患者3例,术后/术前FNMEP波幅比为6.7%(3.5%,7.7%)。术后/术前FNMEP波幅比与术后早期面神经H-B分级呈负相关关系(rs=-0.895,P=0.000)。结论桥脑小脑角区占位切除术中行FNMEP监测可有效保护面神经功能。Objective To analyze the protecting role of facial nerve motor evoked potential(FNMEP)monitoring in facial nerves during the resection of cerebellopontine angle lesions.Methods The clinical data and monitoring data of 83 patients with cerebellopontine angle lesions,accepted intraoperative facial nerve motor evoked potential(FNMEP)monitoring in our hospital from January 2019 to December 2019,were retrospectively investigated.Pre-surgical(opening dural),intraoperative and post-surgical(closing dural)FNMEP amplitudes were recorded.Relation of end(closing dura)to start(opening dura)amplitude ratio with facial nerve function grading at early-term(3 d after surgery)by House-Brackmann(H-B)grading was analyzed.Results In these 83 patients,75 patients(90.4%)achieved total tumor resection,and 8 patients(9.6%)achieved subtotal resection.Integrated anatomical preservation of facial nerves was achieved in all patients(100%);one(1.2%)was died for postoperatively delayed hemorrhage.Three d after surgery,facial nerve H-B grading I-II was noted in 62 patients,and the end to start amplitude ratio was 85.3%(66.8%,93.4%);facial nerve H-B grading III was noted in 11 patients,and the end to start amplitude ratio was 45.6%(38.7%,43.8%);facial nerve H-B grading IV was noted in 7 patients,and the end to start amplitude ratio was 23.1%(16.4%,25.6%);facial nerve H-B grading V-VI was noted in 3 patients,and the end to start amplitude ratio was 6.7%(3.5%,7.7%).There was a negative correlation between end to start FNMEP amplitude ratio and post-surgical early HB grading(rs=-0.895,P=0.000).Conclusion FNMEP is highly reliable in predicting early postoperative facial function during resection of cerebellopontine angle lesions,which can be a valid protection technique for facial nerve.

关 键 词：面神经 运动诱发电位 桥脑小脑角 功能预测 

分 类 号：R651[医药卫生—外科学] R73[医药卫生—临床医学]