脑干听觉诱发电位联合耳蜗电图监测在桥小脑角胆脂瘤切除术中的应用  

Application of brainstem auditory evoked potential combined with cochlear electrogram monitoring in cholesteatoma resection in cerebelloponta angle

作　　者：左颖 王梦欣 刘新怡 张瑜廉 任鸿翔[1] 田宏[1] ZUO Ying;WANG Meng-xin;LIU Xin-yi(Department of Neurosurgery,China-japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院神经外科,北京100029

出　　处：《临床神经外科杂志》2022年第4期427-432,共6页Journal of Clinical Neurosurgery

基　　金：首都卫生发展科研专项项目(202024061)。

摘　　要：目的探讨脑干听觉诱发电位(BAEPs)联合耳蜗电图(ECochG)监测在桥小脑角胆脂瘤切除术中对听觉功能监测的价值。方法回顾性分析中日友好医院神经外科自2018年1月—2020年12月行乙状窦后入路肿瘤切除术治疗的68例桥小脑角胆脂瘤患者的临床资料。根据术中所采取听神经功能监测方法的不同,将患者分成BAEPs监测组(24例)、ECochG监测组(23例)和BAEPs+ECochG监测组(21例)。比较三种监测方法所记录的波形引出率、平均引出时间,术中预警效果,以及术后患者即刻与随访期间听力情况。结果(1)波形的引出率:ECochG监测组(95.7%)>BAEPs监测组(87.5%);平均引出时间:ECochG监测组(9.6 s±3.9)s<BAEPs监测组(58.7 s±28.1)s,差异均有统计学意义(P<0.05);ECochG监测组中CAP波幅明显高于BAEPs监测组中V波波幅,且CAP波潜伏期明显短于V波潜伏期,差异均有统计学意义(P<0.05)。(2)术中预警出现的频率:BAEPs+ECochG监测组(95.2%)>ECochG监测组(69.6%)>BAEPs监测组(62.5%),P=0.031。(3)3组患者术后即刻听力及随访期间听力美国耳鼻咽喉头颈外科学会(AAO-HNS)分级,差异均有统计学意义(H=7.156,P=0.028;H=9.042,P=0.011),平均秩次提示BAEPs+ECochG监测组患者听力均优于其他两组。结论桥小脑角胆脂瘤切除术中,ECochG与BAEPs联合监测可以更加全面、准确、及时地为术者提供听觉传导通路的功能情况,进而对患者听觉功能的保护具有重要意义。Objective To investigate the value of brainstem auditory evoked potential(BAEPs)combined with electrocochleogram(ECochG)monitoring for auditory function in cholesteatoma resection in cerebelloponting angle.Methods The data of 68 patients with cholestatoma of cerebellopontine angle(CPA)who underwent tumor resection through retrosigmoid sinus approach in Department of Neurosurgery,China-Japan Friendship Hospital from January 2018 to December 2020 were retrospectively analyzed.Patients were divided into BAEPs monitoring group(n=24),ECochG monitoring group(n=23)and BAEPs+ECochG monitoring group(n=21)according to the different monitoring methods of intraoperative acoustic nerve function.Waveform extraction rate,mean extraction time,intraoperative warning effect,and hearing status of patients immediately after surgery and during follow-up were compared.Results(1)The extraction rate of waveform was higher in ECochG monitoring group(95.7%)than in BAEPs monitoring group(87.5%).The average extraction time of ECochG monitoring group(9.6±3.9)s was lower than that of BAEPs monitoring group(58.7±28.1)s,and the differences were statistically significant(P<0.05).CAP amplitude in ECochG monitoring group was significantly higher than V amplitude in BAEPs monitoring group,and CAP latency was significantly shorter than V latency,with statistical significance(P<0.05).(2)Frequency of intraoperative warning:BAEPs+ECochG monitoring group(95.2%)>ECochG monitoring group(69.6%)>BAEPs monitoring group(62.5%),P=0.031.(3)There were statistically significant differences in the American Academy of Otolaryngology head and Neck Surgery(AAO-HNS)grading between the 3 groups immediately after surgery and during follow-up(H=7.156,P=0.028;H=9.042,P=0.011),the average rank indicated that the hearing of patients in BAEPs+ECochG monitoring group was superior to the other two groups.Conclusions The combined monitoring of ECochG and BAEPs in cholesteatoma resection in CPA can provide the function of auditory pathway for the surgeon in a more comprehensiv

关 键 词：耳蜗电图 脑干听觉诱发电位 桥小脑角胆脂瘤 

分 类 号：R739.41[医药卫生—肿瘤]