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目的总结桥小脑角区肿瘤术中面神经功能的电生理监测经验。方法对48例桥小脑角区肿瘤病人术中应用肌电图进行连续实时监护,同时进行脑干听觉诱发电位监测。结果术中当接近、触及、牵拉、刺激面神经时,自发肌电图出现突发、双相或多相的高幅电位改变,面神经得以准确定位。脑干听觉诱发电位各波变化中以Ⅴ波潜伏期延长及波幅降低最为显著。肿瘤全切除45例,面神经解剖保留44例,功能保留38例。术后2周House-Brackmann面神经功能分级:Ⅰ￣Ⅱ级38例,Ⅲ￣Ⅳ级8例,Ⅴ级2例;其中Ⅰ￣Ⅱ级的术中刺激值为0.1￣0.2 mA。无死亡及长期昏迷病例。结论突发的双相或多相的高幅肌电图改变,及脑干听觉诱发电位示Ⅴ波潜伏期延长和波幅下降,均为敏感的变化指标;桥小脑角区肿瘤术中实施监护,有助于提高面神经的功能保留率。
Objective To summarize the electrophysiological monitoring experience of facial nerve function in the cerebellopontine angle tumor. Methods 48 cases of cerebellopontine angle tumor patients were treated with EMG continuous real-time monitoring, at the same time for brainstem auditory evoked potential monitoring. Results When the facial nerve approached, touched, pulled and stimulated the facial nerve, the spontaneous EMG burst, biphasic or multiphase high amplitude changes, the facial nerve can be accurately positioned. Brainstem auditory evoked potentials in various wave changes in the Ⅴ wave latency and amplitude decreased the most significant. Total resection in 45 cases of the tumor, facial nerve anatomy retained in 44 cases, 38 cases retained function. House-Brackmann facial nerve function classification was performed at 2 weeks after operation: 38 cases of grade Ⅰ ~ Ⅱ, 8 cases of grade Ⅲ ~ Ⅳ and 2 cases of grade Ⅴ. Among them, the intraoperative stimulation value of grade Ⅰ ~ Ⅱ was 0.1 ~ 0.2 mA. No deaths and long-term coma cases. Conclusions The sudden changes of bipolar or multiphase high amplitude electromyography and brainstem auditory evoked potentials showed the prolonged latency and volatility of Ⅴ wave were sensitive indicators of change; Help to improve facial nerve function retention rate.