多模态术中神经电生理监测技术在Ⅰ型神经纤维瘤病相关周围神经肿瘤手术中的应用  

Application of multimodal intraoperative neurophysiological monitoring technology in neurofibromatosis type 1 related peripheral nerve tumor surgery

作　　者：周维贇 曾宇 欧阳火牛[1] 张文川 王智超 吴祎炜 ZHOU Weiyun;ZENG Yu;OUYANG Huoniu;ZHANG Wenchuan;WANG Zhichao;WU Yiwei(Department of Neurosurgery,Shanghai Ninth People’s Hospital,Shanghai JiaoTong University School of Medicine,Shanghai,200011,P.R.China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People’s Hospital,Shanghai JiaoTong University School of Medicine,Shanghai,200011,P.R.China)

机构地区：[1]上海交通大学医学院附属第九人民医院神经外科,上海200011 [2]上海交通大学医学院附属第九人民医院整复外科,上海200011

出　　处：《中国修复重建外科杂志》2024年第10期1202-1207,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结多模态术中神经电生理监测技术在Ⅰ型神经纤维瘤病(neurofibromatosis type 1,NF1)相关周围神经肿瘤手术中的应用效果及临床经验。方法回顾性分析2019年1月—2023年12月接受多模态术中神经电生理监测下周围神经肿瘤切除手术的94例NF1患者临床资料。男49例,女45例;年龄5~78岁,平均33.7岁。肿瘤形态学分型:结节型71例,弥漫型13例,混合型10例。手术目标肿瘤分布区域:颅面部47例,颈部11例,躯干12例,四肢24例。术前44例无明显神经系统相关症状;其余患者存在神经系统相关症状,包括视力障碍15例、听力障碍5例、躯体运动障碍16例、躯体感觉障碍31例,其中7例同时存在1项以上症状。肿瘤切除术中根据目标肿瘤侵犯区域的相关神经及毗邻重要结构,选择相应的术中神经电生理监测方案,包括视觉诱发电位(17例)、体感诱发电位(44例)、运动诱发电位(88例)、肌电图(94例)监测。结果94例患者均顺利完成手术;除1例患者接受姑息性切除外,其余93例均按术前计划行全/近全切除目标肿瘤。病理检查示神经纤维瘤80例,恶性周围神经鞘瘤14例。术后发生术区血肿2例、切口感染3例,无其他严重并发症发生。患者均获随访,随访时间3~61个月,中位时间15个月。随访期间均未发现明显神经症状改变或肿瘤复发。术前视力障碍患者术后14例无改善,1例改善。躯体运动障碍者术后11例症状无改善、3例减轻、2例加重,新增4例,1例自觉明显影响生活。躯体感觉障碍者术后17例症状无改善、14例减轻,新增13例。听力障碍者术后均较术前改善。结论NF1相关周围神经肿瘤临床表现复杂多样。多模态术中神经电生理监测技术能实时反映神经受激惹/损伤程度,采用其辅助肿瘤切除安全性高,相关并发症较少。Objective To summarize application effect and clinical experience of multimodal intraoperative neurophysiological monitoring(IONM)technology in the surgery of neurofibromatosis type 1(NF1)related peripheral nerve tumors.Methods A retrospective study was conducted on NF1 patients,who admitted between January 2019 and December 2023 and treated with peripheral nerve tumor resection surgery assisted by multimodal IONM technology.There were 49 males and 45 females.The age ranged from 5 to 78 years,with an average of 33.7 years.Tumor morphological classification included 71 cases of nodular type,13 cases of diffuse type,and 10 cases of mixed type.Target tumors were distributed in craniofacial region(47 cases),neck(11 cases),trunk(12 cases),and limbs(24 cases).Preoperatively,44 cases had no obvious neurological symptoms,while the remaining patients had neurological symptoms,including 15 cases of visual impairment,5 cases of hearing impairment,16 cases of somatic movement disorders,and 31 cases of somatic sensory disorders,of which 7 cases had more than one symptom.IONM plans were selected based on the relevant nerves and adjacent important structures of the target tumor,including visual evoked potential(17 cases),somatosensory evoked potential(44 cases),motor evoked potential(88 cases),and electromyogram(94 cases).Results All surgeries were successfully completed.Ninety-three patients underwent total/near total resection and 1 patient underwent palliative resection.Pathological examination showed 80 cases of neurofibroma and 14 cases of malignant peripheral nerve sheath tumors.Complications included 2 cases of hematoma and 3 cases of incision infection.All patients were followed up 3-61 months(median,15 months).During follow-up,no significant changes in neurological symptoms or tumor recurrence were found.Among the patients with preoperative visual impairment,there were 14 cases with no improvement in symptoms and 1 with improvement after surgery.Among the patients with somatic movement disorders,there were 11 cases wit

关 键 词：Ⅰ型神经纤维瘤病 多模态术中神经电生理监测 周围神经肿瘤 

分 类 号：R739.4[医药卫生—肿瘤]