脑干肿瘤切除术中的听性脑干反应分析

目的 探索脑干肿瘤手术中听性脑干反应（ＡＢＲ）变化规律及其监护作用。方法 对５例脑干肿瘤手术患者,从术前、术中至术后进行了ＡＢＲ的动态观察,对术中监护记录的４００余份ＡＢＲ的潜伏期、振幅和波形分化的资料进行分析和统计学处理。结果 术中牵拉、分离、挤压均可引起ＡＢＲⅠ、Ⅲ和Ｖ波潜伏期延长,振幅降低,波形分化差等改变,其中３例动态变化指标好,呈可逆性变化,均康复出院。另２例术后潜伏期持续延长、波形分化     

异常听性脑干反应分析

为了解听性脑干反应（ＡＢＲ）异常的临床诊断价值，报道５６例ＡＢＲ异常的病因和特点，包括手术和／或影像学证明桥小脑角病变２５例，颅内或桥小脑角附近的肿瘤３例，脱髓鞘病变７例，脑梗塞２例，多发性颅神经麻痹１例，肝豆状核变性１例，影像学检查无改变６例，１１例未作进一步检查。这些患者的ＡＢＲ改变多样，即使同一种病变也不尽相同，总的倾向是桥小脑角占位性病变以潜伏期和波间期改变为主，脑干或颅内弥漫性病变以波形分化差和重复性差为主。对ＡＢＲ异常而ＣＴ或ＭＲＩ未见异常的原因作了分析，强调ＡＢＲ是检测蜗后病变非常敏感的指标。     

异常听性脑干反应分析

为了解听性脑干反应（ＡＢＲ）异常的临床诊断价值，报道５６例ＡＢＲ异常的病因和特点，包括手术和／或影像学证明桥小脑角病变２５例，颅内或桥小脑角附近的肿瘤３例，脱髓鞘病变７例，脑梗塞２例，多发性颅神经麻痹１例，肝豆状核变性１例，影像学检查无改变６例，１１例未作进一步检查。这些患者的ＡＢＲ改变多样，即使同一种病变也不尽相同，总的倾向是桥小脑角占位性病变以潜伏期和波间期改变为主，脑干或颅内弥漫性病变以波形     

听性脑干反应在诊断脑干放射性损害中的意义

目的：为探讨听性脑干反应对脑干放射性损害的诊断价值。方法：对放射性脑干脊髓病６例、放疗后１年的鼻咽癌患者１８例和正常对照１５例进行了ＡＢＲ检测。结果：①放射性脑干脊髓病６例均有ＡＢＲ异常,主要表现有Ⅰ－Ⅲ,Ⅲ－Ⅴ及Ⅰ－Ⅴ间期明显延长、未引出ＡＢＲ或波Ⅰ以后各波消失;②ＮＰＣ患者放疗手１年Ⅲ－Ⅴ和Ⅰ－Ⅴ间其均值较放疗前明显延长。结论：ＡＢＲ是检测脑干通路病变的敏感指标,对脑干放射性损害的诊断有一定意     

椎基底动脉短暂缺血性眩晕发病时间与高刺激率听性脑干…

本研究采用高刺激率ＡＢＲ测试６７例不同发病时间的椎基底动脉短暂缺血性眩晕病人以ＡＢＲ５１－１１次／ｓ各波潜伏期与波间期差作为分析参数来探讨ＶＢＴＩＶ发病后不同时间与高刺激率ＡＢＲ波潜伏期的相关性。结果显示；ＶＢＴＩＶ发病后不同时间与高刺激率ＡＢＲ５１－１１次ｓ／Ｖ波，Ⅰ－Ⅴ间期，Ⅲ－Ⅴ间期呈显著性负相关，其测试时间越早，脑缺血程度越重，波潜伏期延长越明显，证实高刺激率ＡＢＲ测试可用于ＶＢＴＩＶ的动     

婴幼儿缺铁性贫血治疗前后脑干听性反应的变化

对５０例（９４耳）缺铁性贫血（ＩＤＡ）患儿治疗前后脑干听性反应（ＡＢＲ）的结果进行分析，认为ＩＤＡ可造成听传导路的周围性损害，主要表现为ＡＢＲ波形分化不良，反应阈值提高，Ⅰ、Ⅲ、Ⅴ波绝对潜伏期（ＰＬ）延长，少数患儿的Ⅰ－Ⅲ峰间期（ＩＰＬ）达临界值，而Ⅲ－ⅤＩＰＬ无异常，经补铁治疗后，ＡＢＲ各参数恢复正常，说明这种改变是可逆的。提示，对小儿ＩＤＡ应早期发现，早期治疗。     

椎基底动脉短暂缺血性眩晕发病时间与高刺激率听性脑干反应潜伏期的相关性研究

本研究采用高刺激率（５１次／ｓ）ＡＢＲ测试６７例不同发病时间（１～７２天）的椎基底动脉短暂缺血性眩晕（ＶＢＴＩＶ）病人，以ＡＢＲ５１－１１次／ｓ各波潜伏期与波间期差作为分析参数来探讨ＶＢＴＩＶ发病后不同时间（天）与高刺激率ＡＢＲ波潜伏期（ｍｓ）的相关性。结果显示：ＶＢＴＩＶ发病后不同时间与高刺激率ＡＢＲ５１－１１次／ｓⅤ波、Ⅰ—Ⅴ间期、Ⅲ—Ⅴ间期呈显著性负相关（相关系数分别为—０．５７、—０．５１、—０．４５，相关系数的ｔ检验，Ｐ＜０．０１），其测试时间越早，脑缺血程度越重，波潜伏期延长越明显，证实高刺激率ＡＢＲ测试可用于ＶＢＴＩＶ的动态监测和提示预后。     

患高脂血症的中老年人听性脑干反应特征

为探讨血脂增高对听阈的影响，对１６例原发性高脂血症无明显听力减退的中老年人分别采用短声重复率２０次／ｓ与４０次／ｓ两种给声方式作了听性脑干反应（ＡＢＲ）测定，并以１２例血脂正常的中老年人和１０例健康年轻人作对照。结果短声重复率增加４０次／ｓ时，高脂血症组的ＡＢＲ波潜伏期和波间期延长，并有显著性差异。表明患高脂血症的中老年人听功能早期有潜在性减退，增加短声重复率能提高ＡＢＲ阳性检出率。     

交叉听力对豚鼠听性脑干反应测试的影响

报告对８只听觉正常的及鼠，观察交叉听力对其耳蜗动作电位和听怀脑干反应测试结果的影响。先手术造成其左耳全聋，然后用四种方法分别记录ＡＢＲ反应阈和Ⅰ波潜伏期。结果发现，术耳虽已全聋，但该侧给声强度达１０ｄＢＨＬ以上时仍可记录到ＡＢＲ，而ＡＰ未能引出，代之出现的却是清晰的ＡＢＲ波形。     

听觉脑干诱发电位波形变化在听神经瘤诊断中的意义

目的探讨听神经瘤病人听觉脑干诱发电位(ABR)波形改变的意义。方法对手术证实为听神经瘤的23例病人ABR的潜伏期、波形进行回顾性分析。结果在23例病人中,11例潜伏期延长,Ⅰ~Ⅴ波间期耳间差(IPL)大于0.4 ms;2例潜伏期延长,但Ⅰ~Ⅴ波间期耳间差小于0.4 ms;2例V波缺失;8例无波形反应。全部患侧波形均异常、重复性差,2例出现对侧波形异常。结论ABR波形变化在听神经瘤诊断中有重大意义;波形异常、重复性差可作为判断ABR异常的辅助指标。     

Auditory brainstem implantation

The use of cochlear implants for selected individuals with bilateral severe to profound sensorineural hearing loss who derive limited benefit from conventional hearing aids is well established. There are situations where cochlear implantation is contraindicated. Auditory brainstem implantation (ABI) is the only solution to restore hearing when the cochlear nerve is disrupted together with pathologies where the cochlea does not provide a suitable location for cochlear implant. Labyrinthine and cochlear aplasia and cochlear nerve aplasia constitute the congenital indications for ABI. In the present review article history and development of ABI, indications, side selection criteria, surgery and audiological outcome are presented.     

听觉脑干植入

听觉脑干植入(ABI)是人工耳蜗植入技术的一种进展,其工作原理与人工耳蜗类似,不同的是人工耳蜗通过电极刺激耳蜗内的听神经纤维而获得听觉,而ABI是将电极越过耳蜗和听神经直接刺激脑干耳蜗核复合体的听神经元产生听觉.就ABI的适应证及禁忌证、手术入路及手术方法、手术并发症以及植入后听力改善的效果等方面进行概述.     

窒息状态下ABR及其脑干功能的实验研究

目的 通过观察豚鼠在窒息状态下ABR电位变化及其脑干功能的自然转归，探讨听觉通路损伤程度和临床意义。方法。听觉诱发电位仪和心电搏氧饱和度监测仪检测3组不同窒息时限的豚鼠的ABR各波潜伏期及波间期，氧饱和度（SO2）及心率（HR）等。结果 波V最易受缺氧的影响，波Ⅲ次之，波I最后消失和最早恢复，窒息时限影响脑干功能，导致1组和2组的各波潜伏期和波间期差有统计学上的意义。窒息时间超过5min30s。实验豚鼠均死亡。结论 ABR可作为窒息状态下判断脑功能及脑死亡的重要辅助指标。应争分夺秒抢救窒息并及时处理心脑的损害。     

The effect of brainstem lesions on brainstem auditory evoked potentials in the cat

Brainstem auditory evoked potentials (BAEPs) were recorded before and after cuts were made in either the midline trapezoid body (TB), the lateral lemniscus (LL), or the combined dorsal and intermediate acoustic striae (DAS/IAS) in 23 anesthetized cats. Monaural and binaural rarefaction clicks were presented at a rate of 10 per s, and the potentials recorded from a vertex electrode referenced to either earbar or to the neck. The potentials were filtered so that fast and slow components could be examined separately and special efforts were exerted to obtain stable conditions so that small changes in waveforms could be significant. Lesions of the DAS/IAS produced negligible changes in either the fast or slow waves. Lesions of the midline TB reduced the amplitudes of peaks P3 through P5, while greatly reducing the amplitude of the slow wave. Complete lesions of the LL always reduced the amplitude of the slow wave. Lesions of the ventral part of the LL were more likely to reduce the amplitude of P4-P5. Our interpretations of these lesion experiments are based on the idea that individual fast peaks of the BAEP represent compound action potentials of fiber pathways. According to this view, only synchronized activity generated in populations of neurons that are both favorably oriented in space and significant in number, will contribute to the fast peak.     

The progress of adrenoleukodystrophy as revealed by auditory brainstem evoked responses and brainstem histology

Summary Serial studies of auditory brainstem evoked responses (ABR) and slow vertex responses (SVR) were obtained during the progress of adrenoleukodystrophy in a 6-year-old boy. This child was normal until 5 years of age. His illness began with a gait disturbance, dysarthria, and hearing difficulty. Later, spastic paralysis, serious deafness, and blindness appeared. He died of respiratory failure 2 years after the onset.The ABR was normal at onset but changed to an abnormal pattern. Initially, there was lengthening of the wave V-I interpeak interval. This was followed by the disappearance of the later components as his general condition deteriorated. At the terminal stage, only a prolonged wave I was recordable. The postmortem pathology revealed demyelination of auditory nerves and remarkable neuronal loss in the auditory pathways of the brainstem; in addition, there was a variety of extensive degeneration throughout the cerebrum, in particular the complete degeneration of the white matter with secondarily occurring ganglionic cell changes. These data suggest that degeneration of the brainstem from rostral to caudal levels occurred.     

Cochlear and brainstem implantation

Cochlear implantation is an established habilitative and rehabilitative option for profoundly deafened individuals over 1 year of age who derive limited benefit from conventional hearing aids. Auditory performance varies among individuals and is determined primarily by age at implantation, pre-existence of speech and language skills, and the time interval between onset of deafness and implantation. Successful implant users generally demonstrate improved auditory abilities and speech production skills beyond those achieved with hearing aids. Multichannel ABIs can provide useful auditory information to patients with NF-2 who have lost integrity of auditory nerves following removal of vestibular schwannomas. The implant allows for awareness of environmental sounds and, potentially, speech recognition. Most patients undergoing implantation demonstrate improved lip-reading skills, and exceptional performers achieve understanding of open-set speech.