神经电生理学监测在脑桥小脑角肿瘤手术中的应用研究

目的：探讨神经电生理监测技术在脑桥小脑角（cerebellopontine angle，cPA）肿瘤手术中的应用价值。方法：选取60例CPA占位病人，行术中神经电生理监测，主要监测三叉、面、迷走、副神经的神经电图和脑干听觉诱发电位（BAEP），观察术后颅神经功能及并发症。结果：60例术中行颅神经的神经电图监测的患者中，56例患者达到了面神经解剖学保留（93％），术后随访面神经功能I-Ⅱ级者31例，Ⅲ-Ⅳ级者10例，V-Ⅵ级者8例；肿瘤全切51例，次全切7例，大部切除者2例。60例患者术中均行健侧BAEP监测，结果以I—V、Ⅲ-V峰间潜伏期（IPL）变化最大。结论：颅神经的神经电生理学监测对CPA肿瘤切除术中面神经解剖学及术后功能保留有重要参考价值，BAEP监测可及时反映术中脑干功能的变化情况。

Application of Electroneurophysiological monitoring in the cerebellar pontine angle tumor surgery

Objective：To explore the applicalion of electroneurophysiological monitoring in cerebel- lar pontine angle （cerebellopontine angle CPA） tumors. Methods： Sixty patients with CPA occupancy, intraoperative electroneurophysiological monitoring, primarily to monitor the trigeminal, facial,vagus, ac- cessory etc, cranial nerves with electroneurography and brainstem auditory evoked potentials （BAEP）, observed postoperative cranial nerve function and complications. Results： Of 60 cases under tntraoperative EMG monitoring of cranial nerves, 56 patients reached a facial nerve anatomy to retain 93% ,and 31 cases belonged to Grades Ⅰ --Ⅱ of postoperative facial nerve function,10 cases Grades Ⅲ-Ⅳ ,8 cases Grades V -Ⅳ ;The tumor was totally removed in 51 cases, sub-totally resected in 7 cases, mostly resectied in 2 cases. All 60 patients underwent surgery under the contralateral BAEP monitoring. The biggest intraop- erative BAEP change was in interval peak latency （IPL）of I -- V and Ⅲ-- V. Conclusion： Cranial nerve EMG monitoring has important value in the cerebellar pontine angle tumor resection and in the anatomy of facial nerve function retaining. BAEP monitoring can reflect different changes during the operation of brainstem functions.