听神经瘤术中神经电生理监护的应用分析

目的研究听神经瘤术中脑干及相应颅神经功能较敏感的电生理监测手段,以达到减少伤残率及提高颅神经的解剖及功能保留率。方法对28例听神经瘤病人,用同一监护仪于手术前、术中及术后分别进行脑干听觉诱发电位(BAEP)及肌电图连续实时监护,观察手术操作对它们的影响。结果听神经瘤手术操作均可以引起BAEP改变,BAEP的Ⅰ、Ⅲ、Ⅴ波潜伏期,Ⅰ-Ⅴ、Ⅲ-Ⅴ峰间潜伏期的明显延长(P<0.05),Ⅴ波波幅明显降低(P<0.05),其中BAEP的Ⅴ波潜伏期及波幅改变最为显著。当接近、触及、牵拉、刺激面神经时,肌电图出现突发的、双相或多相的高幅电位改变,而通过直接电刺激可定位面神经解剖,面神经的解剖及功能保留得以明显提高。结论BAEP的Ⅴ波潜伏期延长和波幅下降以及突发的双相或多相的高幅肌电图改变是听神经瘤术中敏感的电生理指标,对其进行监护,可为术中避免神经功能损伤及术后其功能预测提供客观指标,降低手术伤残率。     

听神经瘤术中面部肌肉肌电图及BAEP的监测与面听神经功能保留：400例临床研究

目的总结听神经瘤术中监测面部肌肉自发与诱发肌电图和脑干听觉诱发电位（BAEP）的经验,分析术中面、听神经解剖功能保留的方法及影响因素。方法使用美国Nicolet公司生产的Viking—Ⅳ型和Axon公司的Epoch XP型多导术中监测仪,对收治的400例听神经瘤患者进行了术中监测面部肌肉自发与诱发肌电图和BAEP。手术切除肿瘤,术后对患者进行面、听神经功能评估。结果肿瘤全切388例（97．70％）,次全切9例,死亡3例。本组病人面神经解剖保留率为95．97％,功能保留率为91．94％。术后主要并发症包括完全性永久性面瘫11例,面部麻木23例,角膜溃疡18例,耳呜29例,后经颅神经瘫痪28例,轻偏瘫3例,听力完全丧失139例。结论通过面部肌肉肌电图及BAEP的监测,可以准确判断颅神经的位置,最大程度避免颅神经的损伤。术中面部肌肉自发与诱发肌电图和BAEP监测,对听神经瘤外科手术的安全性提供了一定的保障,减少了手术的风险,使用得当可降低手术的致残率,应该成为听神经瘤手术的常规工作。     

听神经瘤大小对脑干听觉诱发电位的影响

脑干听觉诱发电位(PEA)检查对于听神经瘤的诊断具有极重要的价值。我院1986年9月至1999年5月收治听神经瘤病人100例,其中84例进行了PEA检查。现将它与听神经瘤的关系分析如下。     

59例听神经瘤患者脑干听觉诱发电位分析

目的 分析听神经瘤(acoustic neuroma,AN)患者的脑干听觉诱发电位的变化特征及健侧耳峰间期改变.方法 对59例听神经瘤(AN)患者进行脑干听觉诱发电位(BAEP)检测,测定Ⅰ、Ⅲ、Ⅴ波潜伏期(PL)、峰间期(IPL),双耳PL、IPL之间差值(ILD)等数值.结合MRI、CT影象学资料进行分析,并与36例健康者对照.结果 AN组与正常对照组BAEP各波PL、IPL测值比较差异有极显著性(P＜0.01).AN患侧BAEP异常率98.3%(58/59);主要表现:①Ⅰ、Ⅲ、Ⅴ波缺失;②Ⅲ、Ⅴ波PL延长;③Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长.AN患者健侧BAEP的异常率69.5%(41/59),主要表现:①Ⅴ波PL延长;②Ⅲ～Ⅴ及Ⅰ～Ⅴ波IPL延长;③Ⅲ～Ⅴ/Ⅰ～Ⅲ波IPL比值＞1.肿瘤直径＞2cm,BAEP的异常率有显著提高.不同大小肿瘤组间健侧BAEP测值比较:健侧Ⅴ波PL差异有显著性(P＜0.05),Ⅲ～Ⅴ及Ⅰ～ⅤIPL差异有极显著性(P＜0.01).结论 BAEP对AN诊断具有重要意义,它为病变提供了定位诊断依据,尤其健侧Ⅲ～Ⅴ/Ⅰ～Ⅲ波IPL比值异常,是脑干受压的敏感指标.     

巨大型听神经瘤术中面听神经的保留

巨大型听神经瘤与周围结构粘连紧密，手术切除并保留周围颅神经功能是神经外科手术的一个难点。我科自1994年1月至2001年9月间共收治听神经瘤80例，直径均大于4cm，现报告如下。     

听神经瘤术后听力保留三个问题

听神经瘤的早期诊断和治疗在过去３０年中有大进展［１］,如面神经功能保留率、降低死亡率等方面取得了明显进步。现在众多学者特别关注保护和改善蜗神经功能一听力保留问题,期望在这一方面对降低听神经瘤致残率有所贡献。 听力保留在显微外科操作技术上面临３个问题［２］：①肿瘤全切,保留听力;②完善显微操作技术,预防听力迟发性损害;③预防恶性耳鸣。本文拟对上述３个问题结合文献综述如下。１肿瘤全切,保护听力显微外科技术１．１手术入路［１～５］对手术入路的选择,多数学者主张采用乙状窦后经内耳道方法。对于较大的肿瘤（…     

听神经瘤显微手术保留听神经功能及影响因素分析

目的　探讨听神经瘤显微手术保留听神经功能及其影响因素。方法　收集我院近 2年来 2 3例经枕下乙状窦后入路显微手术的初发听神经瘤资料 ,其中包括肿瘤大小、术前术后听力、肿瘤内听道底侵蚀及术后小脑损伤情况。结果　耳蜗神经解剖保留 1 9例 ,保留有效听力 2例 (占术前存在有效听力患者的 33 3 % ) ,有效听力丧失保留可测听力 1 0例。听力的保留与肿瘤大小、术前听力水平、肿瘤内听道底侵蚀、小脑损伤相关。结论　肿瘤的大小、术前听力水平、肿瘤内听道底侵蚀和小脑损伤是听神经瘤术后听神经功能保留的影响因素。     

40例听神经瘤病人的脑干听觉诱发电位分析

目的：探讨听神经瘤患者的脑干听觉诱发电位（ＢＡＥＰ）变化规律及应用价值。方法：对听神经瘤患者作常规ＢＡＥＰ检查。结果：４０便听神经瘤肿瘤侧ＢＡＥ异常率１００％,非肿瘤侧ＢＡＥＰ异常率９０％,以Ⅲ－Ⅴ间期延长尤显著,Ⅲ－Ⅴ／Ⅰ－Ⅲ比值中７２％,结论：听力减退患者进行ＢＡＥＰ测试,对听神经瘤的诊断和鉴别诊断具有重要意义。     

影响听神经鞘瘤术后有效听力的因素分析

目的分析听神经鞘瘤显微术后影响有效听力的因素。方法 47例听神经鞘瘤在术中听力监护下行枕下乙状窦后入路显微切除术。记录肿瘤的大小、术前听力、肿瘤存内听道的充满程度以及肿瘤与听神经的粘连程度。结果肿瘤均全切,听神经解剖保留75．7％,47例病人有效听力保留率为21．2％。肿瘤直径≤15 mm的28例中有效听力保留率为32．2％,肿瘤直径≥16 mm的19例中有效听力保留率为5．3％。在25例病人中,影像资料显示16例内听道被肿瘤完全充满者有效听力保留率为25％,9例内听道部分充满者有效听力保留率为44．4％。28例肿瘤直径≤15 mm的病人中,16例术前听力为Ⅰ级者术后有效听力保留率为37．5％,12例Ⅱ级以上者(包括Ⅱ级)术后有效听力保留率为 25％。肿瘤大小与内听道充满程度可作为术后有效听力独立影响因素(P<0．001,P=0．027)。而术前听力无统计学意义(P=0．233)。结论肿瘤不完全充满内听道以及其直径小于15 mm有利于有效听力保留,良好的术前听力似乎更有利于有效听力保留,但却没有统计学意义。肿瘤与听神经没有完整界面, 这一点会影响术后有效听力的保留。     

听神经瘤的听力保留问题

听神经瘤系桥脑小脑角(CPA)发病率最高的肿瘤,如何对其早期诊断、及时给予手术治疗并术后能保存听力,是外科医生关注的问题。目前的研究表明,部分听神经瘤病人术后确实可达到长期保留听力的效果。本文对保留听力的适应症、手术入路、术中监护、术后随访及各作者的观察结果进行了复习。     

脑干听觉诱发电位对癫(癎)患儿检测的意义

目的探讨脑干听觉诱发电位在癫患儿检测中的意义。方法对2000-01~2008-01我院38例癫患儿BAEP的检测结果进行总结。结果BAEP正常15例(39.5%),异常23例(60.5%),其中21例BAEP改变形式多样,异常指标相混出现。结论癫患者存在脑干功能异常。     

脑干听觉诱发电位在面肌痉挛显微血管减压术中的应用价值

目的探讨脑干听觉诱发电位（BAEPs）V波潜伏期和（或）波幅的变化与面肌痉挛（HFS）显微血管减压术（MVD）后听力损失的应用价值。 方法选取中日友好医院神经外科自2015年9月至2019年8月行MVD治疗的HFS患者的临床资料，分析MVD始末BAEPs的V波潜伏期和波幅的变化以及手术前后听力状况的改变，听力学评估采用平均纯音听力阈值及言语识别率改变。根据美国耳鼻咽喉头颈外科学会分级方法，将术后患者听力分为听力未明显下降组和听力明显下降组。收集术中全程的BAEPs改变，并将BAEPs的V波术中改变分为：无显著异常，单纯V波潜伏期（LwV）延长>1.5 ms，单纯V波波幅（AwV）下降>50%，LwV延长>1.5 ms且AwV下降>50%，LwV延长>1.5 ms或AwV下降>50%，对5组分类模式下术后听力损伤程度与分组的相关性进行统计分析，并分析4组BAEPs改变对术后听力损伤的预测价值。 结果本研究纳入的1009例行MVD治疗的HFS患者中，943例患者听力未明显下降，66例患者术后听力异常，术中BAEPs监测波形无显著改变，术后出现听力下降5例（0.6%）；术中仅LwV延长>1.5 ms，术后出现听力下降4例（18.2%）；术中仅AwV降低>50%，术后出现听力下降19例（25.0%）；术中"LwV延长>1.5 ms且AwV降低>50%"，术后出现听力下降38例（64.4%）；术中"LwV延长>1.5 ms或AwV降低>50%"，术后出现听力下降61例（38.8%）。各组的阳性预测值比较，结果显示"LwV延长>1.5 ms且AwV降低>50%"最高；"LwV延长>1.5 ms或AwV下降>50%"组的敏感度最高；"LwV延长>1.5 ms且AwV下降>50%"组的特异度最强。 结论术中BAEPs监测可为MVD术者提供听力参考。术末V波潜伏期延长1.5 ms且波幅降低50%以上阳性预测值最高。术中根据BAEPs监测结果及时调整手术策略，可有效改善术后听力障碍的发生率。     

脑创伤后长期意识障碍患者脑干听觉诱发电位表现与预后清醒的关系

目的 探讨重型创伤性颅脑损伤(TBI)后长期意识障碍患者脑干听觉诱发电位(BAEP)表现与预后清醒的关系.方法 分析63例重型TBI后意识障碍超过2周患者的BAEP表现,主要为BAEP中Ⅰ、Ⅲ、Ⅴ波各波峰潜伏期(PL),Ⅰ～Ⅲ、Ⅲ～Ⅴ波峰间潜伏期(IPL)及Ⅰ波与Ⅴ波波幅比.预后以TBI后6个月患者是否清醒为标准,分为清醒组与未清醒组,组间运用两独立样本t检验以筛选出有意义的指标.结果 本组患者清醒率为34.9%(22/63),BAEP指标异常率为66.7%(42/63).双侧Ⅰ、Ⅲ、Ⅴ波PL,Ⅰ～Ⅲ波、Ⅲ～Ⅴ波IPL及Ⅰ/Ⅴ波幅比均正常的21例中有16例清醒(清醒率为76.2%),双侧Ⅴ波PL异常的8例及双侧Ⅲ～Ⅴ波IPL异常的7例均未清醒,单侧Ⅴ波消失的2例未清醒.清醒组与未清醒组间比较发现双侧差异均有统计学意义的指标为Ⅴ波PL及Ⅲ～Ⅴ波IPL.结论 BAEP的Ⅴ波PL及Ⅲ～Ⅴ波IPL变化可客观、准确地反映脑损伤的程度及预测患者的预后.

Abstract：

Objective To explore the correlation between brainstem auditory evoked potential (BAEP) findings and outcome in long-term unconscious patients with severe traumatic brain injury (TBI).Methods BAEP findings were recorded and analyzed in 63 patients suffering from severe TBI with duration of disturbance of unconsciousness for more than 2 weeks. The peak latency (PL) of wave Ⅰ, Ⅲ and Ⅴ, the interpeak latency (IPL) of wave Ⅰ-Ⅲ and Ⅲ-Ⅴ and the amplitude ratio of wave Ⅰ and Ⅴ were analyzed. Conscious or unconscious at 6 months after the injury was considered as the outcome criterion,and based on these, the patients were divided into conscious and unconscious groups; the significant indicators were chosen in the 2 groups using independent-sample t test. Results The probabilities of awakening in these patients were 34.9% (22/63) with abnormal index of BAEP indicators reaching 66.7%. Sixteen patients were sober at last in 21 patients with normal PL of wave Ⅰ, Ⅲ and Ⅴ, IPL of wave Ⅰ-Ⅲ and Ⅲ-Ⅴ, and amplitude ratio of wave Ⅰ and Ⅴ in bilateral side (the probabilities of awakening were 76.2%); 8 patients having abnormal PL of wave Ⅴ in bilateral side and 7 having abnormal IPL of wave Ⅲ-Ⅴ in bilateral side were unconscious; 2 patients having disappeared wave Ⅴ in unilateral side were unconscious. PL of wave Ⅴ and IPL of wave Ⅲ-Ⅴ in bilateral side were significantly different between the conscious group and the unconscious group. (P＜0.05). Conclusion BAEP findings (PL of wave Ⅴ and IPL of wave Ⅲ-Ⅴ in bilateral side) can objectively and accurately demonstrate the cerebral dysfunction and predict the outcome of the patients.     

2型糖尿病患者脑干听觉诱发电位的改变及相关因素分析

目的分析2型糖尿病(2DM)患者脑干听觉诱发电位(BAEP)的改变,从而探讨BAEP对糖尿病患者脑干功能损害的检测价值。方法对50例2型糖尿病患者进行脑干听觉诱发电位(BAEP)检测,比较听觉通路左右耳损害及周围段与中枢段损害差别,并分析病程、空腹血糖对BAEP的影响。结果 (1)2DM患者BAEP左右耳比较潜伏期(PL)及潜伏期差(IPL)差异无统计学意义。(2)2DM患者BAEP中枢段与周围段比较,中枢段损害重于周围段,差异有统计学意义。(3)2DM患者BAEP异常与病程有相关性,与空腹血糖无相关性。结论 BAEP检测对2DM患者在无脑部受损临床症状时可以早期发现听神经是否受累及受累部位。     

听神经瘤手术内听道处理及面听神经保护

目的探讨听神经瘤手术内听道内肿瘤的处理方法,并对显微解剖保留面神经的手术经验和技巧进行讨论,以提高肿瘤的全切率和面神经的保留率。方法回顾性分析经枕下乙状窦后-内听道入路显微外科手术治疗的听神经瘤49例,术前行CT内耳道薄层扫描,术中行面神经功能和脑干听觉诱发电位监测。对听神经瘤内听道处理的手术技巧进行分析。结果术中面神经解剖保留43例,面神经解剖保留率为87.8%,出院时功能保留35例(H-B分级,Ⅰ~Ⅱ级)。解剖未能保留6例,其中2例行面神经端-端吻合。肿瘤全切45例,全切除率为91.8%;近全切除4例。术后无死亡病例。结论熟悉内听道内面听神经与肿瘤的病理解剖关系,熟练掌握显微手术技巧并结合术中监测,对肿瘤全切除和面听神经功能保护具有重要的意义。     

前庭阵发症脑干听觉诱发电位的特点

目的探讨前庭阵发症(VP)脑干听觉诱发电位(BAEP)的特点。方法对51例VP患者的BAEP结果进行回顾性分析。结果 BAEP异常者40例,异常率为78.4%。与Ⅰ-Ⅲ波峰间期正常的患者相比,Ⅰ-Ⅲ波峰间期延长的患者男性比例高(χ2=4.763,P=0.029),病程显著延长(t=2.469,P=0.021),而平均年龄差异无统计学意义。与Ⅲ-Ⅴ波峰间期正常的患者比较,Ⅲ-Ⅴ波峰间期延长的患者男性比例、平均病程、平均年龄差异均无统计学意义。与Ⅰ-Ⅲ波峰间期耳间差正常的患者比较,Ⅰ-Ⅲ波峰间期耳间差延长的患者病程相对较长(P=0.055),男性有增多趋势(P=0.058),但差异无统计学意义。结论 VP患者BAEP异常以Ⅰ-Ⅲ波峰间期延长为主,且以男性更多见。病程越长,蜗神经越易受累。     

婴儿痉挛症脑干听觉诱发电位中的γ频带

目的 观察婴儿痉挛症患者脑干听觉诱发电位中γ频带成分。方法 用子波变换分别对正常婴儿、婴儿痉挛症患儿、经过一段时间治疗后的婴儿痉挛症患儿脑干听觉诱发电位信号进行多尺度分析。观察脑干听觉诱发电位信号多尺度成分的分尺度功率随尺度的分布。结果 婴儿痉挛症患儿的脑干听觉诱发电位信号的γ频带的成分缺损严重，其分尺度功率远低于正常婴儿，婴儿痉挛症患儿经过一段时间治疗后脑干听觉诱发电位信号的γ频带成分明显改善，其分尺度功率接近正常婴儿。结论 γ频带对信启在脑干中的接收、传输、加工、综合、反馈等高级功能和人脑的认知活动具有重要作用，γ频带成分缺损导致的信息传导阻滞是引起患儿智能发育迟滞的原因。     

Characteristics of brainstem auditory evoked potential of neonates with mild or moderate hyperbilirubinemia

BACKGROUND: Brainstem auditory evoked potential (BAEP) has been widely used to evaluate the functional integrity and development of injured auditory system and brain, especially to objectively evaluate the function of auditory system and brain stem of very young babies, such as neonates and sick babies. OBJECTIVE: To observe the changes of BAEP of neonates with hyperbilirubinemia, and to investigate the relationship of bilirubin concentration and BAEP. DESIGN: An observation experiment. SETTING: Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA. PARTICIPANTS: Fifty-eight neonates with mild or moderate hyperbilirubinemia exhibiting jaundice within 24 hours after born, who received the treatment in the Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA between January 2004 and May 2007, were recruited in this study. The involved neonates, 31 boys and 27 girls, had gestational age of 37 to 46 weeks. They had no history of birth asphyxia, and were scored 8 to 10 points when born. Written informed consents of examination and treatment were obtained from the guardians of the neonates. This study was approved by the Hospital Ethics Committee. According to serum total bilirubin value, the neonates were assigned into 3 groups: low-concentration bilirubin group (n =16), moderate-concentration bilirubin group (n =27) and high-concentration bilirubin group (n =15). According to mean daily bilirubin increase, the subjects were sub-assigned into bilirubin rapid increase group (n =39) and bilirubin slow increase group (n =19). METHODS: After admission, all the neonates received drug treatment. Meanwhile, their 116 ears were examined with a myoelectricity evoked potential equipment (KEYPOINT) in latency, wave duration, amplitude and wave shape differentiation of each wave of BAEP. BAEP abnormal type was observed and abnormal rate of BAEP was calculated. MAIN OUTCOME MEASURES: ① Abnormal rate and abnormal type of BAEP. ② Latency of waves Ⅰ, Ⅲ　and Ⅴ, and wave duration of waves Ⅰ to Ⅲ, Ⅲ to Ⅴ, and Ⅰ to Ⅴ. RESULTS: Fifty-eight neonates with mild or moderate hyperbilirubinemia were involved in the final analysis. ①Abnormal type and abnormal rate of BAEP of neonates with hyperbilirubinemia: Among the 116 ears, unilateral or bilateral waves Ⅰ, Ⅲ, Ⅴ still existed. The latency of waves Ⅰ, Ⅲ and Ⅴ was +2.5 s longer than the normal level in 8, 4 and 15 ears, respectively. The wave duration of waves Ⅰ to Ⅲ and waves Ⅲ to Ⅴ was +2.5 s longer than the normal level in 6 and 14 ears, respectively. The wave duration of waves Ⅲ to Ⅴ was longer than that of ipsilateral waves Ⅰ to Ⅲ in 24 ears. The latency difference of wave Ⅴ between two ears was larger than 0.4 ms in 31 neonates with hyperbilirubinemia; The amplitude of wave Ⅴ to that of ipsilateral wave I was lower than 0.5 in 29 neonates. Totally 52 ears were abnormal, and the abnormal rate was 44.8%. One to two months later, 98% abnormal neonates with hyperbilirubinemia recovered. The abnormal rate in the low-, moderate-, and high-concentration bilirubin groups was 37.5%, 44.4% and 53.3%, respectively. ② Comparison of latency and wave duration of each wave of BAEP: Latency of waves Ⅰ, Ⅲ and Ⅴ, and wave duration of waves Ⅰ to Ⅲ and Ⅲ to Ⅴ were gradually prolonged in low-, moderate-, and high-concentration bilirubin groups, but significant difference did not exist between two groups (P > 0.05). ③ There were no significant differences in latency of waves Ⅰ, Ⅲ and Ⅴ, and wave duration of waves Ⅰ to Ⅲ, Ⅲ to Ⅴ and Ⅰ to Ⅴ between bilirubin rapid increase group and bilirubin slow increase group (P > 0.05). CONCLUSION: Auditory acuity and brainstem of neonates with mild or moderate hyperbilirubinemia are damaged to some extent. High-concentration bilirubin causes BAEP abnormality easily. Bilirubin increase and its concentration change are not consistent with nervous lesion degree.     

脑干听觉诱发电位检测对儿童颅内压增高的诊断意义

目的探讨脑干听觉诱发电位(brainstem anditory evoked potential,BAEP)在儿童颅内压(incranium pressure,ICP)增高诊断中的作用。方法本文采用MEB-9100型脑干诱发电位仪对颅内压增高患儿50例进行脑干听觉诱发电位检查。结果脑干诱发电位正常21例(42.0%),异常29例(58.0%)。结论脑干听觉诱发电位无损伤、可重复、波形稳定、不受意识状态及镇静剂影响、客观性强,可为儿童颅内压增高的临床诊断提供科学依据,对评价预后、指导治疗有一定的临床意义。