听神经瘤术中面神经电生理监测的问题与对策

目的 探讨听神经瘤术中面神经电生理监测技术的常见问题与对策,提高面神经解剖保留率,并对解剖保留的面神经进行功能评价.方法 25例听神经瘤患者手术时均在面神经电生理监测下进行,全部采用枕下乙状窦后入路,显微外科切除肿瘤,肿瘤切除后对面神经功能进行评价.结果 肿瘤全切除25例(100%),无手术死亡;面神经解剖保留23例,占92%.面神经功能状态H-B分级Ⅰ、Ⅱ级19例,Ⅲ、Ⅳ级5例,Ⅴ级1例.术末刺激强度越小,术后面神经功能越好;低于0.5 mA同时面肌肌电波幅大于100 μV,面神经功能可达Ⅰ～Ⅱ级;术末刺激强度大于2 mA波幅反应不明显时,术后面神经功能恢复不理想.结论 术中自发或诱发式神经电生理监测技术的灵活应用可明显提高面神经解剖保留率和功能保留率,对其定量分析有助于术后面神经功能的判断.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

听神经瘤显微手术与面神经保护

目的探讨大中型听神经瘤的显微手术治疗及面神经保护技巧。方法自2007年9月至2011年9月在面神经电生理监测下采用枕下乙状窦后入路显微手术切除大中型听神经瘤142例。结果肿瘤全切除136例（95．7％）,次全切除6例（4．3％）。术中面神经解剖保留132例（93．0％）,面神经与肿瘤粘连紧密无法保留10例（7．0％）。本组无长期昏迷及死亡病例。术后出现颅内感染3例、后组颅神经受损7例、眼睑闭合不能90例,无脑脊液漏病例。所有病人术后均随访3个月到2年,无术后复发病例;按House—Braekmann分级评估面神经功能,Ⅰ～Ⅱ级78例（54．9％）,Ⅲ～Ⅳ级53例（37．3％）,Ⅴ～Ⅵ级11例（7．8％）。结论充分了解桥脑小脑角区显微解剖知识,特别是了解听神经瘤与面神经的解剖关系,有助于提高手术效果。娴熟的操作技巧是手术成功的关键,术中监测及面神经的保留有助于面神经功能的保护。     

大型听神经瘤显微切除术中应用IFNM技术可视化面神经

目的探讨术中面神经监测(IFNM)技术在显微切除大型听神经瘤过程中保留面神经的效果。方法对86例单侧大型听神经瘤(直径≥3cm)病人采用枕下乙状窦后入路显微切除肿瘤。切开肿瘤背侧包膜前,根据电刺激肿瘤表面及边缘产生的激发性肌电图来探查并确认面神经的行走路径;术中采用自发性肌电图监测面神经,使其免受牵拉、挤压或损伤,交替采用激发性肌电图实时探查、确认面神经,从而在虚拟状态下达到面神经"可视化"。结果本组肿瘤全切除79例,占91.9%;次全切除5例,占5.8%;大部分切除2例,占2.3%。面神经解剖保留74例,保留率达86.0%;实用听力保留28例,占32.6%。术后面神经功能House-Brackman分级:Ⅰ～Ⅱ级64例,占74.4%;Ⅲ～Ⅳ级15例,占17.4%;Ⅴ～Ⅵ级7例,占8.2%。结论采用IFNM技术术中"可视化"面神经是大型听神经瘤切除术后面神经得以保留的关键,而娴熟的显微手术技巧、扎实的桥小脑角局部解剖知识是手术成功的保障。     

听神经瘤术中面神经监测的临床意义

目的 探讨听神经瘤术中面神经监测对面神经保护的临床意义.方法 24例患者分为术中面神经监测组(12例)和术中无面神经监测组(12例),通过House-Brackmann评分标准评价两组患者术前、术后2周的面神经功能状态;同时比较两组面神经解剖保留率情况.结果 对两组患者术前、术后2周的面神经功能状态数据进行分析,两组术前面神经功能差异无统计学意义,术后2周面神经功能差异有统计学意义;无监测组面神经解剖保留率为67%,监测组为92%.结论 面神经监测有助于听神经瘤术中面神经的保护,提高患者的生活质量.     

大型听神经瘤术后面神经功能的动态变化

目的探讨大型听神经瘤面神经解剖保留后面神经功能变化.方法对31例解剖保留面神经的大型听神经瘤的面神经功能行动态观察.结果术后1 d、3 d、1周、3个月、6个月和1年,面神经功能达House-BrackmannⅡ级者分别为74.19%、16.13%、9.68%、18.18%、52.38%和66.67%,A组(31～40 mm)和B组(41～50 mm)面神经功能术后3 d较术后1 d明显恶化,3个月时已稳定,术后6个月较术后3 d明显改善.C组(>50 mm)虽术后3 d较术后1 d变化不明显,但术后1周较第3 d时恶化,术后1年较术后1周明显改善.结论面神经解剖保留并不意味着功能的保留,面神经解剖保留后常出现面神经功能的恶化.肿瘤小于和/或等于50 mm者面神经功能恶化发生较早,功能改善较早,而肿瘤大于50 mm者面神经功能恶化发生较晚,功能改善较晚.     

听神经瘤涉及的面神经段显微解剖学研究

目的探讨听神经瘤涉及的面神经段的显微解剖，为听神经瘤手术提供解剖学数据。方法利用福尔马林充分同定的15例成人尸头标本，对面神经的脑干端、桥小脑角段、内耳道段及其毗邻结构进行测量和拍照。结果面神经脑干端与周围解剖结构有恒定距离。桥小脑角段由面神经运动根、中间神经两个根组成，与前庭蜗神经走行关系恒定。内耳道段处面神经运动根在前庭蜗神经前上方，中间神经和面神经运动根在内耳道中部合成一干，近内耳道底处面神经在内耳道底的横嵴上．垂直嵴前走行。结论研究听神经瘤涉及的面神经段显微解剖，有助于听神经瘤的切除．保护面神经。     

弥散张量成像在听神经瘤术中面神经定位中的应用价值

目的探讨术前弥散张量成像(DTI)在听神经瘤手术面神经定位中的应用价值。方法回顾性分析2017年5月至2019年10月德阳市人民医院神经外科手术治疗的17例听神经瘤患者的临床资料。术前采用DTI重建追踪面神经的位置,以术中神经电生理监测结果作为金标准,计算DTI定位面神经的灵敏度、特异度、准确率及曲线下面积(AUC);采用Kappa一致性检验评价术前DTI重建面神经的结果与术中神经电生理监测面神经定位的一致性。结果17例患者术前行DTI重建均成功追踪面神经,术中采用神经电生理监测均成功定位面神经的实际位置,其中15例与术前DTI重建面神经的位置相符合,2例与DTI不相符合,包括1例术中神经电生理监测显示面神经位于肿瘤腹侧前上部,而术前DTI显示面神经位于肿瘤上级,1例术中神经电生理监测显示面神经位于肿瘤腹侧前下部,而术前DTI显示面神经位于肿瘤下级术前DTI定位面神经的灵敏度为83.3%,特异度为80.0%,准确率为76.5%,AUC=0.900(P=0.011),与术中神经电生理监测定位面神经具有一定的一致性(Kappa=0.734,P<0.01)。结论术前011对听神经瘤手术中面神经的定位具有较高的特异性,有助于术中保护面神经,从而减少面神经的损伤。     

不同麻醉方法在听神经瘤切除术时面神经监测中的应用比较

目的 探讨比较无肌松剂辅助下七氟烷复合瑞芬太尼和丙泊酚复合瑞芬太尼这两种麻醉方法用于听神经瘤切除术时面神经监测的效果及安全性. 方法 广东三九脑科医院麻醉科自2011年10月至2012年12月在无肌松剂辅助全麻下行听神经瘤切除加面神经监测63例,其中应用七氟烷复合瑞芬太尼麻醉32例,丙泊酚复合瑞芬太尼麻醉31例.比较2组患者入室(T0)、切皮(T1)、探查面神经走行(T2)、处理脑干面肿瘤(T3)、术毕(T4)时平均动脉压(MAP)、心率(HR)、体动及面神经监测情况. 结果 丙泊酚复合瑞芬太尼组患者术中MAP、HR平稳,各时间点间比较差异无统计学意义(P＞0.05).而与丙泊酚复合瑞芬太尼组相同时间点比较,七氟烷复合瑞芬太尼组患者T2、T3时MAP较高、HR较低,差异均有统计学意义(P＜0.05).2组患者均无明显体动并收集到有意义的自发肌电信号,监测成功率100％. 结论 无肌松剂辅助下七氟烷复合瑞芬太尼和丙泊酚复合瑞芬太尼这两种麻醉方法均能满足听神经瘤切除术中面神经监测要求,麻醉效果亦可满足手术要求,其中丙泊酚复合瑞芬太尼能更好地维持血流动力学平稳.     

大型听神经瘤的显微手术治疗及术中面神经保护

目的 探讨显微手术切除大型（肿瘤最大径>3 cm）听神经瘤的疗效及术中面神经保护的方法。方法 回顾性分析2014年1月至2018年2月手术治疗的86例大型听神经瘤的临床资料,均在电生理监测下采用枕下乙状窦后入路显微手术。结果 肿瘤全切除83例,近全切除3例。面神经保留78例（91%）;术后1周面神经功能House-Backmann分级:1级11例,2级37例,3级22例,4级16例。术后门诊随访3~30个月,术区皮下积液4例,口唇疱疹9例,无死亡病例。结论 术前多模态肿瘤-神经评估,术中实时电生理监测,精细显微手术对大型听神经瘤全切和保留面神经功能可提供保障。     

术中面神经监测在听神经瘤术中对面神经的保护意义

目的探讨术中面神经监测在听神经瘤术中对面神经的保护意义,并对解剖保留的面神经的功能进行评价。方法 53例听神经瘤患者在手术时均采用英国Oxford-instrumen公司生产的神经电生理监测仪进行术中面神经监测。全部采用经枕下乙状窦后入路,显微镜下手术切除肿瘤,肿瘤切除后对面神经进行功能评价。结果面神经解剖保留率90.5%,6个月后功能保留率为84.9%。结论术中面神经监测在听神经瘤术中有助于确定面神经的位置,提高面神经的解剖及功能保留率。