IFNM 技术在听神经瘤患者手术中的应用价值分析

摘要

ObjectiveToassessthevalueofneurophysiologicalmonitoringinpreservingthefacialnervein microsurgeryforacousticneuroma.Methods 45patientswithacousticneuromaweredividedintomonitoringgroup and non-monitoring group .The tumor was removed under the microscope without intraoperative facial nerve monitoring in 22 cases and with intraoperative monitoring in 23 cases.All the patients were followed up .Results House-Brack-mann system was used to evaluate the function of the facial nerve 6 months after the operation .Among the 23 cases in monitoring group,gradeⅠwas observed in 13 cases,gradeⅡin 3 cases and grade Ⅲin 2 case;among the 22 cases in non monitoring group , gradeⅠwas observed in 5 cases, gradeⅡin 2 cases, gradeⅢ in 2 cases, with signficant differences ( P<0.05) .Conclusion The difference is avoiding the nerve injury .EMG could help confirm the integ-rity of the postoperative facial nerve .The minimal stimulating intensity which can derive EMG is related with the prog-nosis of facial nerve function after total resection of the tumor .Neurophysiological monitoring may effectively preserve the facial nerve function in microsurgery for acoustic neuroma .%目的：探讨听神经瘤显微切除术中的电生理监测（IFNM）对面神经功能保护的影响。方法45例听神经瘤患者分别行单纯显微镜下切除肿瘤（非监测组，22例），显微镜下切除肿瘤过程中使用美国Bio-logic神经生理术中监测系统，对面神经进行监测（监测组，23例），观察术中面神经实时监测情况，随访所有患者术后面神经功能。结果通过术中监测自发肌电图（ EMG）结合、电刺激诱发EMG可以精确判断面神经的位置。本监测组23例听神经瘤，术后6个月面神经H-B分级，Ⅰ级13例、Ⅱ级3例、III级2例；非监测组22例听神经瘤，Ⅰ级5例、Ⅱ级2例、Ⅲ级2例，差异有统计学意义（ P＜0．05）。结论术中神经电生理监测可以为手术时避免损伤面神经提供依据；肿瘤切除后可帮助确认面神经结构是否完整；全切肿瘤后引出EMG的最小电刺激强度与面神经预后密切相关。听神经瘤手术中行神经电生理监测可有效保护面神经。