听神经瘤术中面神经功能监测120例临床研究

目的 了解面神经监测的方法学、准确性、实用性以及术中监测和面神经预后的关系，实现解剖保留面神经，提高肿瘤全切率的目的。方法 术中使用美国Viking—IV型多导术中监测仪监测自发和诱发面肌肌电图。120例听神经瘤中包括小型听神经瘤3例；中型听神经瘤9例；大型听神经瘤108例，均进行术中面神经监测。结果 通过术中监测自发EMG结合单极恒压电刺激诱发EMG可以精确判断面神经的位置，损伤较机械刺激小。本组结果提示术毕在面神经出脑干端刺激时，若刺激量在1V，0.1ms,术后2周面肌功能在H—B分级的I级，长期随访效果理想。结论 刺激量由大到小，距离由远及近，定位准确、及时，并可判断面神经预后。全切肿瘤后电刺激强度与面神经预后密切相关。

Clinical investigations on 120 acoustic neuromas with multimodality intraoperative monitoring of facial nerves

Obj ec tive The aim of intraoperative monitoring is to preserve facial nerve and other cranial nerves at the basis of total tumors removal.Methods We reported120 cases of acoustic neuromas with intraoperative mutimodality monitoring of facial nerve,acoustic nerve and trigeminal nerve.119patients underwent operation with retrosigmoid approach and one with translabyrinth ap proach.Results Const ant monopolar voltage stimuli could identify the position of facial nerve preci se ly.The electrical injury to facial nerve is smaller than mechanic stimulate .The ratio of facial nerve preservation is96.67%.If the stimulate is1V (0.1ms),the facial nereve function is I grade of House-Brack maan classif ication at discharge and numbers of H-B grade I patients increased greatly foll owing up in1year later.Conclusion The stimulate intensity is from low to high step by step and the distance to nerve is from remote to vicinity.The electrica l stimulate can identify the position of fa cial nerve quickly and precisely.St imulate at the exit of facial nerve from brainstem can predict the acute and fin al facial nerve function following acoustic neuroma resection.