面神经运动诱发电位监测在前庭神经鞘瘤手术中的应用价值  

Application value of facial nerve motor evoked potential monitoring in vestibular schwannoma surgery

作　　者：杨丽蕊 管修东 乔慧[1] Yang Lirui;Guan Xiudong;Qiao Hui(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学,北京市神经外科研究所,北京100070 [2]首都医科大学附属北京天坛医院神经外科学中心,北京100070

出　　处：《中华神经外科杂志》2024年第2期154-160,共7页Chinese Journal of Neurosurgery

摘　　要：目的 探讨面神经运动诱发电位(FNMEP)监测对前庭神经鞘瘤手术患者术后面神经功能结局的预测价值.方法 回顾性分析2020年5-12月首都医科大学附属北京天坛医院神经外科学中心收治的60例前庭神经鞘瘤患者的临床资料.所有患者术中均在眼轮匝肌、口轮匝肌及颏肌上记录FNMEP,并计算缝合硬脑膜时的FNMEP波幅下降率.分别在术后1周、术后6个月采用面神经功能House-Brackmann分级系统(简称H-B分级)评价患者的面神经功能,并将其分为面神经功能良好组(H-B分级≤Ⅱ级)和面神经功能不良组(H-B分级>Ⅱ级).比较两组患者的临床资料,将P<0.20的指标纳入多因素logistic回归分析探讨患者术后面神经功能结局的影响因素.使用受试者工作特征(ROC)曲线及其曲线下面积(AUC)确定预测前庭神经鞘瘤患者术后面神经功能结局的临界值及其预测效能.结果 60例患者中,眼轮匝肌、口轮匝肌及颏肌的FNMEP引出率分别为40.0%(24/60)、91.7%(55/60)和 98.3%(59/60).术中达到肿瘤全切除的患者共 48 例(80.0%).术后1周、术后6个月面神经功能良好的患者分别占26.7%(16/60)、68.3%(41/60).单因素分析结果显示,术后1周,两组患者间眼轮匝肌、口轮匝肌的FNMEP波幅下降率的差异均有统计学意义(均P<0.05).术后6个月,两组患者间肿瘤最大直径,眼轮匝肌、口轮匝肌及颏肌的FNMEP波幅下降率的差异均有统计学意义(均P<0.05).多因素logistic回归分析结果显示,FNMEP在口轮匝肌的波幅下降率为术后 1 周(OR=1.03,95%CI:1.01~1.06,P=0.015)、术后6 个月(OR=1.05,95%CI:1.02~1.08,P=0.001)患者面神经功能结局的预测因素,其临界值分别为33.2%、48.7%(AUC分别为0.736、0.829,均P<0.05).结论 术中FNMEP监测可以有效反映前庭神经鞘瘤患者的术后面神经功能结局,尤其是其在口轮匝肌上的记录结果,推荐以波幅下降率>50%为术中预警标准.ObjectiveTo investigate the predictive value of intraoperative monitoring of facial nerve motor evoked potentials(FNMEPs)on facial nerve function(FNF)post vestibular schwannoma(VS)surgery.MethodsA retrospective analysis was conducted on the clinical data of 60 patients with VS who were admitted to the Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University from May 2020 to December 2020.FNMEP was recorded on the orbicularis oculi,orbicularis oris and mentalis muscles of all patients during the operation,and the FNMEP amplitude decrease rate when the dura mater was sutured was determined.The patients′facial nerve function was evaluated using the House-Brackmann facial nerve function grading system(referred to as H-B classification)1 week and 6 months after surgery,and they were divided into a group with good facial nerve function(H-B classification≤gradeⅡ)and a group with poor facial nerve function(H-B classification>gradeⅡ).The clinical data of the two groups of patients were compared,and indicators with P<0.20 were included in multivariate logistic regression analysis to explore the predictive factors of postoperative facial nerve function outcomes.The receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to determine the critical value and predictive efficacy for predicting facial neurological outcome after VS surgery.ResultsAmong 60 patients,the successful induction rates of FNMEPs from the orbicularis oculi,orbicularis oris and mentalis muscles were 40.0%(24/60),91.7%(55/60)and 98.3%(59/60)respectively.Total tumor resection was achieved in 48 patients(80.0%)during surgery.The proportion of patients with good facial nerve function at 1 week and 6 months after surgery accounted for 26.7%(16/60)and 68.3%(41/60)respectively.The results of univariate analysis showed that 1 week after surgery,the differences in the amplitude reduction rates of FNMEP in the orbicularis oculi and orbicularis oris muscles between the two groups were statistically significant(both P<

关 键 词：神经瘤 听 神经电生理监测 治疗结果 面神经功能 预测价值 

分 类 号：R651.11[医药卫生—外科学]