摘要
目的总结分析术中神经电生理监测结合显微手术操作技巧在听神经瘤手术中预防面神经损伤的作用。方法选取我科2011～2012年施行乙状窦后入路显微手术的大型及中型听神经瘤(肿瘤直径≥2.4 cm)患者62例,术中应用神经电生理监测技术对手术进行综合监护,同时密切留意骨性解剖、蛛网膜解剖、神经与血管解剖关系。术后随访6个月,评估肿瘤切除程度并根据House-Brack-mann面神经功能分级对患者面神经功能进行评估。结果肿瘤全切除58例(93.5%),次全切除4例(6.5%);无围手术期死亡患者。面神经功能评定:Ⅰ级57例(91.9%),Ⅱ级5例(8.1%)。结论对于大型和中型听神经瘤患者,术中进行综合电生理监护,同时操作时注意典型的解剖位置与熟练的显微手术技术,可达到较高的肿瘤全切除率,并尽可能地保全面神经功能。
Objective To summarize and analyze the effect of intraoperative neurophysiological monitoring combining with surgical techniques on avoidance of facial nerve injury during microsurgery of acoustic neuroma. Methods 62 patients with acoustic neuroma of medium to large size （ diameter ≥ 2.4 cm ） received tumor removal via suboccipital retrosigmoidal approach from 2011 to 2012. During operation, the facial nerve was reserved with intraoperative neurophysiological monitoring and the anatomic relationships among the bone, arachnoid, nerve and vascular structure were observed particularly. The patients were followed up for 6 months and the function of the facial nerve was evaluated according to the House-Brackmann system. Results Total tumor resection was achieved in 58 of 62 patients （93.5%） and subtotal in 4 （6.5%） , no patient died. As for the facial nerve function, recovery of normal function （ grade I ） was achieved in 57 cases （ 91.9 % ） , grade II in 5 cases （ 8. 1% ） , and none of grade III （0.0 % ）. Conclusion Neurophysiological monitoring and microneurosurgical techniques are helpful for total tumor resection and keeping facial nerve anatomic intact in microsurgery of medium to large acoustic neuroma.
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2013年第1期1-4,8,共5页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
基金
2011年国家临床重点专科建设项目
关键词
听神经瘤
神经电生理监护
乙状窦后入路
面神经
显微手术
Aacoustic neuroma
Neurophysiological monitoring
Suboccipital retrosigmoidal approach
Facial nerve
Microsurgery
