术中面神经运动诱发电位对小脑脑桥角区肿瘤患者面神经功能预测价值的Meta分析  

Meta-analysis of the predictive value of intraoperative facial nerve motor evoked potentials on facial nerve function for patients with cerebellopontine angle area tumors

作　　者：张晗曦 宗轶烜 胡悦 方媛[2] Zhang Hanxi;Zong Yixuan;Hu Yue;Fang Yuan(Department of Neurosurgery,Chengdu Fifth People's Hospital,Chengdu 611130,China;Department of Neurosurgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]成都市第五人民医院神经外科,成都611130 [2]四川大学华西医院神经外科,成都610041

出　　处：《中华神经外科杂志》2024年第11期1160-1168,共9页Chinese Journal of Neurosurgery

摘　　要：目的系统评价术中面神经运动诱发电位(FNMEP)对小脑脑桥角区肿瘤患者术后面神经功能的预测价值。方法计算机检索PubMed、Embase、Cochrane Library、维普、中国知网、万方数据库中发表于2005年1月至2023年11月的关于将术中FNMEP用于小脑脑桥角区肿瘤患者术后面神经功能预测的诊断研究, 不限语种及地区。由2名研究者独立提取数据, 采用QUADAS-2量表评价文献质量。使用Stata 17.1软件进行Meta分析, 评价术中FNMEP对小脑脑桥角区肿瘤术后早期(术后<1周)及远期(术后≥6个月)面神经功能的预测价值, 计算合并灵敏度及合并特异度, 绘制综合受试者工作特征曲线并计算曲线下面积(AUC)。以I2值定量分析异质性, 若I2≤50%则采用固定效应模型分析;若I2>50%采用随机效应模型分析。根据不同预警标准(波幅或阈值法)、不同肿瘤类型(听神经瘤或非听神经瘤患者)进行亚组分析。结果纳入19项研究共1 494例患者。Meta分析结果显示, FNMEP对术后早期及远期面神经功能预测的合并灵敏度分别为0.85(95%CI:0.77~0.90, P<0.001)、0.89(95%CI:0.79~0.95, P<0.001), 合并特异度分别为0.92(95%CI:0.87~0.96, P<0.001)、0.93(95%CI:0.73~0.99, P<0.001), 合并AUC分别为0.94(95%CI:0.92~0.96, P<0.001)、0.93(95%CI:0.90~0.95, P<0.001)。亚组分析显示, 波幅法和阈值法的合并灵敏度均为0.85(均P<0.05), 合并特异度分别为0.92、0.94(均P<0.05);非听神经瘤组和听神经瘤组的合并灵敏度分别为0.97、0.85(均P<0.05), 合并特异度分别为0.93、0.84(均P<0.05)。结论术中FNMEP对小脑脑桥角区肿瘤患者术后早期和远期面神经功能均具有较高的预测价值。Objective To systematically evaluate the predictive value of intraoperative facial nerve motor evoked potentials(FNMEP)on facial nerve function after surgery for patients with cerebellopontine angle area tumorsM.Iethods A computer search was performed on PubMed,Embase,Cochrane Library,VIP,CNKI,and Wanfang database for articles published from January 2005 to November 2023 on the diagnostic research on intraoperative FNMEP for predicting facial nerve function after surgery for tumors in the cerebellopontine angle area,regardless of language or region.Two researchers independently extracted data and used the QUADAS-2 scale to evaluate the quality of the literature.Meta-analysis was performed using Stata(17.1)software to evaluate the predictive value of intraoperative FNMEP for facial nerve function in the early postoperative period(<1 week after operation)and long-term(≥6 months after operation)for tumors in the cerebellopontine angle area.The combined sensitivity and combined specificity were calculated.The receiver operating characteristic curve was drawn and the area under the curve(AUC)was calculated.Heterogeneity was quantitatively analyzed using the P value.If P was≤50%,the fixed effect model was used for analysis;if P was>50%,the random effects model was used for analysis.Subgroup analysis was conducted based on different early warning criteria(amplitude or threshold method)and different tumor types(acoustic neuroma or non-acoustic neuroma patients).Results A total of 19 studies with a total of 1,494 patients were included.Meta-analysis results showed that the combined sensitivity of FNMEP for predicting early and long term facial nerve function after surgery was 0.85(95%CI:0.77-0.90,P<0.001)and 0.89(95%Cl:0.79-0.95,P<0.001)respectively,the combined specificities were 0.92(95%Cl:0.87-0.96,P<0.001)and 0.93(95%CI:0.73-0.99,P<0.001)respectively,and the combined AUCs were 0.94(95%Cl:0.92-0.96,P<0.001)and 0.93(95%CI:0.90-0.95,P<0.001)respectively.Subgroup analysis showed that the combined sensitivities of the

关 键 词：颅底肿瘤 小脑脑桥角 神经电生理监测 面神经 诱发电位 运动 META分析 

分 类 号：R739.4[医药卫生—肿瘤]