弥散张量成像在听神经瘤术中面神经定位中的应用价值  

Application of diffusion tensor imaging in localization of facial nerve during the operation of acoustic neuroma

作　　者：李新军[1] 韩杨云[1] 孙中书[1] 叶锋[1] 陈晨[1] 邹林波[1] 刘盈盈[1] 惠旭辉[2] Li Xinjun;Han Yangyun;Sun Zhongshu;Ye Feng;Chen Chen;Zou Linbo;Liu Yingying;Hui Xuhui(Department of Neurosurgery,People's Hospital of Deyang City,Deyang 618000,China;Department of Neurosurgery,West China Hospital of Sichuan University,Chengdu 610000,China)

机构地区：[1]德阳市人民医院神经外科,四川618000 [2]四川大学华西医院神经外科,成都610000

出　　处：《中华神经外科杂志》2021年第2期144-148,共5页Chinese Journal of Neurosurgery

基　　金：四川省科技厅科技支撑计划(2016SZ0015)。

摘　　要：目的探讨术前弥散张量成像(DTI)在听神经瘤手术面神经定位中的应用价值。方法回顾性分析2017年5月至2019年10月德阳市人民医院神经外科手术治疗的17例听神经瘤患者的临床资料。术前采用DTI重建追踪面神经的位置,以术中神经电生理监测结果作为金标准,计算DTI定位面神经的灵敏度、特异度、准确率及曲线下面积(AUC);采用Kappa一致性检验评价术前DTI重建面神经的结果与术中神经电生理监测面神经定位的一致性。结果17例患者术前行DTI重建均成功追踪面神经,术中采用神经电生理监测均成功定位面神经的实际位置,其中15例与术前DTI重建面神经的位置相符合,2例与DTI不相符合,包括1例术中神经电生理监测显示面神经位于肿瘤腹侧前上部,而术前DTI显示面神经位于肿瘤上级,1例术中神经电生理监测显示面神经位于肿瘤腹侧前下部,而术前DTI显示面神经位于肿瘤下级术前DTI定位面神经的灵敏度为83.3%,特异度为80.0%,准确率为76.5%,AUC=0.900(P=0.011),与术中神经电生理监测定位面神经具有一定的一致性(Kappa=0.734,P<0.01)。结论术前011对听神经瘤手术中面神经的定位具有较高的特异性,有助于术中保护面神经,从而减少面神经的损伤。Objective To investigate the application value of preoperative diffusion tensor imaging(DTI)in localization of facial nerve in acoustic neuroma surgery.Methods A retrospective analysis was conducted on the clinical data of 17 patients with acoustic neuromas who were treated at Department of Neurosurgery,Peopled Hospital of Deyang City from May 2017 to October 2019.DTI was used to identify the position of facial nerve before operation,and the results of neuroelectrophysiological monitoring were used as the gold standard.The sensitivity,specificity,accuracy and area under curve(AUC)of DTI were calculated.Kappa consistency test was used to evaluate the consistency between preoperative DTI localization and intraoperative neuroelectrophysiological monitoring of facial neive.Results In ail 17 cases,the facial nerve was successfully traced with DTI before operation.Intraoperative was used to map the actual position of facial nerve,in this series,neuroelectrophysiological monitoring was consistent with DTI in 15 cases and not consistent with preoperative DTI description in 2 cases.Out of the 2 cases,intraoperative neuroelectrophysiological monitoring showed that the facial nerve was located in the anterior upper part of the ventral side of the tumor in 1 case,while preoperative DTI showed that the facial nerve was in the upper region of the tumor;and the facial nerve was localed in the anterior lower part of the tumor by intraoperative neuroelectrophysiological monitoring in 1 case,while preoperative DTI showed that the facial nerve was located in the lower region of the tumor.The sensitivity,specificity,accuracy and AUC of DTI were 83.3%,80.0%,76.5% and 0.900 respectively(P=0.011).The location of facial nerve identified by DTI was consistent with that by intraoperative neuroelectrophysiological monitoring(Kappa=0.734,P<0.01).Conclusion Preoperative DTI has a high specificity in the localization of facial nerve during operation of acoustic neuroma,which helps to protect the facial nerve during operation and thus reduce t

关 键 词：神经瘤 听 面神经 弥散张量成像 电生理监测 

分 类 号：R651.3[医药卫生—外科学]