大型听神经瘤术中肌电图,脑干听觉诱发电位对面神经功能保留？…

目的研究面肌肌电图（ＥＭＧ）、脑干听觉诱发电位（ＢＡＥＰ）监护技术在大型听神经瘤手术中对面神经保留的作用。方法经枕下入路行显微手术全切除肿瘤,术中同时监测面ＥＭＧ、ＢＡＥＰ。结果肿瘤全切率１００％,面神经解剖保留率９４％,功能保留良好率８１％。术末刺激强度≤０．４ｍＡ提示预后良好。结论大型听神经瘤显微手术中,通过面ＥＭＧ、ＢＡＥＰ监护可显提高面神经的功能保留率并能提供指标提示预后。     

脑干听觉诱发电位对听神经瘤诊断敏感性研究

目的探讨听神经瘤患者脑干听觉诱发电位的异常表现及诊断价值.方法对确诊的30例听神经瘤患者作常规脑干听觉诱发电位检查.结果正常1例,异常29例(96.7%),肿瘤侧表现为主波缺失、潜伏期(PL)及峰间期(IPL)延长,非肿瘤侧以IPL(Ⅲ～Ⅴ)/(Ⅰ～Ⅲ)>1为主要表现.结论脑干听觉诱发电位对听神经瘤具有高度敏感性,对听神经瘤的诊断具有重要意义.     

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例听神经瘤肿瘤侧 BAEP 异常率100%,非肿瘤侧 BAEP 异常率90%,以Ⅲ-Ⅴ间期延长尤显著(占90%),Ⅲ-Ⅴ/Ⅰ-Ⅲ比值异常占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。     

神经-肌电图监护在巨大听神经瘤术中的应用

1．1 对象 我院2002-04～2003-11巨大听神经瘤术监护12例．男8例．女4例，年龄36～58岁，平均47岁，病程1～10a，平均5．5a。患侧听力下降或消失12例。头昏头痛10例，耳鸣9例，行走不稳易向同侧偏斜8例，面部麻木12例，轻度面瘫2例，中度面瘫6例．重度面瘫4例，视力下降6例，恶心、呕吐6例．咀嚼困难3例，吞咽困难、声嘶2例。     

听神经瘤患者的脑干听觉诱发电位研究

【目的】探讨脑干听觉诱发电位（BAEP）在听神经瘤诊断中的应用价值。【方法】对经手术和病理证实资料完整的听神经瘤患者23例行脑干听觉诱发电位检查。【结果]23例患者中听力异常23例（26耳）,占100％。其中轻度6耳,中度15耳,重度5耳。BAEP异常21例,占91．3％（21／23）。患侧Ⅰ、Ⅲ、Ⅴ波消失或分化不良17例,占73．90o（17／23）;患侧Ⅰ、Ⅲ、Ⅴ波潜伏期延长12例,占52．1％（12／23）;对侧异常主要表现为Ⅲ～Ⅴ间期大于Ⅰ～Ⅲ间期17例,占73．9％（17／23）。【结论】脑干听觉诱发电位是一种敏感的检测方法,对听神经瘤的诊断具有重要的临床价值。     

听神经鞘瘤术后监护

本文回顾我院后颅窝开颅听神经鞘瘤手术１８例的临床监护，因手术涉及脑干、延髓生命中枢，易导致呼吸循环中枢衰竭，且有后组颅神经的损害，出现吞咽困难，饮水呛咳现象，强调手术后呼吸功能监护的重要性，本组５例发生中枢性呼吸衰竭，作者认为术后除观察脑科常规外，还应严密监护术后出血、脑水肿、脑室引流和颅内压，并发消化道应激性溃疡出血，因此术后严密临床监护，以确保病人安全渡过手术后的危险期，对提高神经外科临床护理质量有一定的指导意义。     

三种不同脑干疾病的脑干听觉诱发电位的比较

目的 比较不同脑干疾病的脑干听觉诱发电位(BAEP)改变，总结其各自的特征点，为临床不同脑干疾病的诊断及鉴别诊断提供可参考的电生理依据。方法 对80例椎-基底动脉供血不足患者、56例听神经瘤患者、47例慢性小脑变性疾病患者分别作BAEP检查，并与50例健康者对照。结果 三组患者BAEP的异常率分别为73．75％，94．61％，89．36％，具体成分异常各有其特点。结论 三种不同性质的脑干疾病BAEP改变各有特点，对临床各种脑干疾病的诊断及鉴别诊断具有一定意义。     

脑干听觉诱发电位在后颅窝肿瘤术中对神经功能的实时监测

目的:研究脑干及与相应颅神经功能损伤时敏感的电生理指标,为后颅窝肿瘤手术提供精确、准确和安全的术中监测手段。方法:30例后颅窝肿瘤患者,使用同一多功能神经电生理监护仪进行术中脑干听觉诱发电位(BAEP)连续实时监护,测定手术操作对这些指标的影响。结果:后颅窝肿瘤手术及其操作可以引起BAEP的改变。手术中BAEP的I波(1.76±0.08)ms,III波(4.45±0.20)ms,V波(6.67±0.13)ms潜伏期,I～V(5.01±0.31)ms,III～V(2.40±0.14)ms,峰间潜伏期较手术开始时明显延长(t=8.216,6.816,25.087,7.343,11.585,P<0.01),V波幅(0.39±0.07)μV明显降低(t=3.565,P<0.01)。其中以BAEP的Ⅴ波潜伏期及波幅改变最为显著。结论:BAEP的Ⅴ波潜伏期延长和波幅下降是后颅窝肿瘤术中敏感的电生理指标,对其进行监护,可为手术中及手术后避免神经功能损伤提供客观指标,降低手术伤残率,减少或避免患者手术后神经功能损伤。     

脑干损伤病人的脑干反射和脑干听觉诱发电位研究

目的 :探讨脑干反射 (BSR)和脑干听觉诱发电位 (BAEP)在观察脑干损伤病人的病情变化、判断预后方面的价值。方法 :对 70例脑干损伤病人同时进行BSR、BAEP监测。分析BSR、BAEP与格拉斯哥昏迷计分 (GCS)、格拉斯哥预后分级 (GOS)之间的关系以及 2 5例临终状态时BSR、BAEP情况 ,同时研究早期脑疝病人的BAEP变化。结果 :BSR、BAEP与病人的GCS、GOS密切相关 ,BSR平面越低 ,病情越重 ,预后越差 ;BAEP异常程度与病情轻重基本一致 ,双侧或一侧Ⅰ、Ⅲ、Ⅴ波平坦 ,提示预后不佳。脑死亡者绝大多数BSR属Ⅵ平面 ,BAEP双侧各波呈电平坦。脑疝早期BAEP主要表现为一侧波Ⅴ消失或波Ⅰ～Ⅴ、Ⅲ～Ⅴ峰间潜时 (IPL)延长。结论 :BSR、BAEP可用来观察病情、判断预后 ,可作为脑死亡的诊断标准之一 ,BAEP有助于早期发现脑疝 ,指导治疗     

大型听神经瘤显微外科手术中的面听神经功能保护

目的应用显微外科技术行大型听神经瘤手术,探讨提高大型听神经瘤全切率和面、听神经的保留率,达到最大程度的功能康复。方法42例均采用枕下一乙状窦后入路,显微外科技术行肿瘤切除术。结果肿瘤全切除37例(88%),次全切除5例(12%)。术中面神经解剖保留34例(81%),面神经功能H—B分级Ⅰ、Ⅱ级14例(41%),Ⅲ、Ⅳ级12例(35%),Ⅴ、Ⅵ级8例(24%);听神经解剖保留16例(38%),功能保留8例(19%)。无手术死亡。结论应用显微镜外科技术是提高大型听神经瘤切除率及面、听神经解剖和功能保留的关键。     

听神经瘤术中面神经功能监护的手术配合

随着显微外科技术的改进与术中面神经监测的应用听神经瘤术后面神经的保留率为95%~98%[1]。尤其对较大听神经瘤,术中应用神经生理监测仪可有效寻找出面神经的部位与走向,并加以保护。我院于2003年4月至2004年4月对22例听神经瘤病人应用神经生理监测仪,通过面肌电图对术中面神经     

桥小脑肿瘤术中神经功能监测判定面神经的预后

目的使用多导监护仪进行桥脑小脑角肿瘤的多组颅神经术中监测,以监测面神经为主。方法总结60例桥小脑角肿瘤术中监测的经验,其中听神经瘤为47例。使用Viking-IV型多导监护仪,监测自发和诱发的面肌、咬肌和斜方肌肌电图。诱发肌电图使用单极恒压电刺激。结果单极恒压电刺激诱发肌电图可以精确判断面神经的位置,损伤较机械刺激小。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。本组结果提示术毕在面神经出脑干端刺激时,刺激量在1V,0.1ms时,术后2周面肌功能在H-B分级的I级。术中监测后面神经保留率为93.6%。其他运动性颅神经均解剖保留。结论术中面神经功能监测是提高肿瘤全切率和面神经保留率的理想方法,并可提供面神经术后康复的依据。     

Intraoperative recurrent laryngeal nerve monitoring in unconventional thyroid surgery

The most common surgical risk after total thyroidectomy remains the recurrent laryngeal nerve (RLN) injury. Nowadays, the use of intraoperative nerve monitoring systems (IONM) such as the endotracheal tube‐based is recommended to prevent RLN palsy. The use of the nerve monitoring is standardized by dedicated guidelines on the basis of a normal laryngeal anatomy, but previous head and neck surgical procedures may complicate its application. The authors herewith present a case of a non‐conventional use of endotracheal tube‐based IONM in a 72‐year‐old patient who underwent to a second‐stage total thyroidectomy for metastatic papillary cancer incidentally detected after an open partial horizontal laryngectomy (OPHL) extended to one arytenoid (Type IIa + ary left) for squamous cell carcinoma. The use of the endotracheal tube‐based IONM in such particular case where the function of the only remaining arytenoid had to be absolutely preserved was effective in avoiding the RLN accidental injury. The authors reviewed the non‐traditional use of IONM and described the procedure in case of thyroidectomy in patients previously treated by OPHL.     

大型听神经瘤的显微手术治疗

目的总结大型听神经瘤的显微手术经验。方法回顾性分析经枕下一乙状窦后人路21例大型听神经瘤的显微手术。结果本组病例全切或近全切18例（85．7％）;大部分切除3例（14．3％）;面神经解剖保留16例（76．2％）;死亡1例（4．8％）。结论采用经枕下一乙状窦后人路显微久科技术切除大型听神经瘤是一种安全、有效的方法。     

Postoperative headache following acoustic neuroma resection: occipital nerve injuries are associated with a treatable occipital neuralgia

Objective.— To demonstrate that occipital nerve injury is associated with chronic postoperative headache in patients who have undergone acoustic neuroma excision and to determine whether occipital nerve excision is an effective treatment for these headaches. Background.— Few previous reports have discussed the role of occipital nerve injury in the pathogenesis of the postoperative headache noted to commonly occur following the retrosigmoid approach to acoustic neuroma resection. No studies have supported a direct etiologic link between the two. The authors report on a series of acoustic neuroma patients with postoperative headache presenting as occipital neuralgia who were found to have occipital nerve injuries and were treated for chronic headache by excision of the injured nerves. Methods.— Records were reviewed to identify patients who had undergone surgical excision of the greater and lesser occipital nerves for refractory chronic postoperative headache following acoustic neuroma resection. Primary outcomes examined were change in migraine headache index, change in number of pain medications used, continued use of narcotics, patient satisfaction, and change in quality of life. Follow‐up was in clinic and via telephone interview. Results.— Seven patients underwent excision of the greater and lesser occipital nerves. All met diagnostic criteria for occipital neuralgia and failed conservative management. Six of 7 patients experienced pain reduction of greater than 80% on the migraine index. Average pain medication use decreased from 6 to 2 per patient; 3 of 5 patients achieved independence from narcotics. Six patients experienced 80% or greater improvement in quality of life at an average follow‐up of 32 months. There was one treatment failure. Occipital nerve neuroma or nerve entrapment was identified during surgery in all cases where treatment was successful but not in the treatment failure. Conclusion.— In contradistinction to previous reports, we have identified a subset of patients in whom the syndrome of postoperative headache appears directly related to the presence of occipital nerve injuries. In patients with postoperative headache meeting diagnostic criteria for occipital neuralgia, occipital nerve excision appears to provide relief of the headache syndrome and meaningful improvement in quality of life. Further studies are needed to confirm these results and to determine whether occipital nerve injury may present as headache types other than occipital neuralgia. These findings suggest that patients presenting with chronic postoperative headache should be screened for the presence of surgically treatable occipital nerve injuries.     

内镜引导下手术切除内耳道内听神经鞘瘤

目的 探讨内镜技术在切除内耳道（IAC）内听神经鞘瘤术中的价值.方法 对4年来21例听神经鞘瘤患者,进行显微手术切除长入桥小脑角部分的肿瘤后,不磨除IAC后壁而直接采用内镜引导下切除IAC的残余肿瘤.术中在切除IAC内肿瘤前、后刺激IAC口处面神经,记录肌电图.术后1～3个月复查MRI及面神经功能评定,得出IAC内肿瘤全切率和面神经解剖保留率.结果 21例患者IAC内肿瘤全切除18例;IAC段面神经解剖保留16例.全部病例无死亡,无术后脑脊液漏.结论 对IAC明显扩大的听神经鞘瘤患者,采用不磨除IAC骨结构,使用合适的成角手术器械,在内镜辅助下直接切除长入IAC内的肿瘤可获得较好的治疗结果,且可避免术后脑脊液漏等并发症的发生.     

Headaches after acoustic neuroma surgery

Headache and depression were studied in patients who had undergone operation for acoustic neuroma. A questionnaire with headache and Beck Depression Inventory scale were sent to 228 patients, of whom 192 (84%) responded. Preoperative headache was reported by 61 (32%) of the respondents (47 migraine and nine tension-type headache) and 122 (64%) respondents had postoperative headache (15 new migraine and four new tension-type headache). The new postoperative headache was chronic (≥3 months) in 86% and continued at the time of the survey in 55% and presented typically as severe short-lasting attacks provoked by physical stress, bending or coughing. Non-steroidal anti-inflammatory drugs were effective in most cases. Depression (usually mild) occurred in 24% of the respondents, being significantly more common in prolonged postoperative headache patients. The operation doubled the prevalence of headache (from 32% to 64%). Headache after acoustic neuroma operation appears to be a specific subgroup of postcraniotomy headache.     

囊性听神经瘤CT诊断1例

患者,女,27岁,自感面部不适,脑CT检查(图1):左侧桥小脑角区一大小约5.0 cm×3.5 cm×3.5 cm的囊实性占位,外缘边界清晰,其内实质部分大小约2.0 cm×1.0 cm×2.0 cm(箭头),病灶压迫脑干及左侧小脑半球,第四脑室受压变形,左侧桥小脑脚池消失,左侧内听道扩大.经手术病理证实为听神经瘤,囊壁组织都是由典型的Schwann细胞组成,而无特异性的其他细胞.     

Headache after resection of acoustic neuroma

Long-lasting severe headaches are reported to occur in up to 83% of patients who have undergone resection of acoustic neuroma, especially through a suboccipital approach. These headaches, however, are not well defined. The objective of this study was to assess the frequency and character of new-onset headaches after resection of acoustic neuroma by a suboccipital approach with cranioplasty. Review of the medical record was followed by a telephone interview with 48 patients (67% female; mean age, 52 years) who had undergone resection of an acoustic neuroma through a suboccipital craniotomy during the 2 years before the study. Of the 48 patients, 58% had post-operative head pain that lasted more than 7 days and could be categorized into two types. A moderate to severe, short-term head pain with gradual resolution occurred in 35% of the patients, and a mild, unremitting pain was reported by 23%. Both types of pain had a dull ache or pressure quality and were adjacent to or confined to the incisional area. Overall, 77% of the patients were pain-free within 4 months after operation. Age, sex, tumor size, or preoperative history of headache did not influence development of the postoperative pain.
We found that new-onset headache after resection of acoustic neuroma by a suboccipital approach with cranioplasty is much less common than previously reported and is best described as mild incisional pain rather than a severe headache. The literature regarding headaches after different surgica1 approaches for acoustic neuroma resection is reviewed, and possible explanations for development of the pain are discussed.