论文部分内容阅读
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。
Objective To investigate the effect of intraoperative facial nerve monitoring (IFNM) technique in preserving the facial nerve during the microsurgical removal of large acoustic neuromas. Methods 86 patients with unilateral large acoustic neuroma (diameter ≥ 3cm) were treated with suboccipital sigmoid sinus retrosigmoid microsurgery. Before incision of the tumor dorsal envelope, the facial nerve was walked and traced according to the electromyography of stimulating the tumor surface and the edge of the tumor. The facial nerve was monitored by spontaneous electromyography to avoid stretching, Squeeze or injury, alternate live EMG real-time exploration to confirm the facial nerve, so as to reach the facial nerve in the virtual state “visual ”. Results The total resection of tumors in this group 79 cases, accounting for 91.9%; subtotal resection in 5 cases, accounting for 5.8%; the majority of resection in 2 cases, accounting for 2.3%. Facial nerve anatomy retained 74 cases, the retention rate was 86.0%; Practical hearing retention in 28 cases, accounting for 32.6%. House-Brackman classification of facial nerve function: 64 cases of grade Ⅰ ~ Ⅱ, accounting for 74.4%; Ⅲ ~ Ⅳ grade in 15 cases, accounting for 17.4%; Ⅴ ~ Ⅵ grade in 7 cases, accounting for 8.2%. Conclusions Intraoperative “visualization” of facial nerve with IFNM technique is the key to preserve facial nerve after large acoustic neuroma resection. Skilled microsurgical skills and solid anatomy of cerebellopontine angle are the key to successful operation.