摘要
目的研究全程面神经监测即术前应用磁共振弥散张量成像(DTI)技术行面神经成像、术中联合面神经电生理监测技术,探讨其在听神经瘤术中面神经保护的意义。方法选取2016年1月—2017年1月南昌大学附属赣州医院收治的听神经瘤患者11例,术前采用面神经DTI显示肿瘤与面神经的关系,术中行面神经动态、电刺激肌电图,并检验DTI对面神经的定位准确与否,术后评估面神经功能。结果 11例听神经瘤面神经可通过DTI技术显示,面神经均位于肿瘤腹侧,7例位于肿瘤中部1/3,2例位于肿瘤下部1/3,2例位于肿瘤上部1/3,术前定位结果与术中所见吻合率为100%。10例肿瘤全部切除,1例内听道部分肿瘤残余。术中面神经动态肌电图监测可提示及定位面神经,11例面神经均解剖保留,保留率为100%。术后随访1~12个月,面神经功能House-BrackmannⅠ级4例,Ⅱ级6例,Ⅲ级1例。结论通过术前面神经DTI和术中神经电生理监测的全程监测技术,有助于术中定位和保护面神经,可提高听神经瘤术中面神经的解剖及功能保留率。
Objective To investigate the effect of facial nerve monitoring by preoperative facial nerve imaging（ FNI）via diffusion tensor imaging（ DTI）,combined with intraoperative electrophysiologic facial nerve monitoring for the protection of facial nerve during the acoustic neuroma surgery. Methods The enrolled participants were 11 consecutive cases of acoustic neuroma who received treatment in Ganzhou Hospital Affiliated to Nanchang University from January 2016 to January 2017. All of them underwent DTI for examining the ubiety between the facial nerve and acoustic neuroma preoperatively,and facial nerve dynamic electromyography（ ECG） and electrical stimulation-evoked facial nerve EMG intraoperatively. The position of the facial nerve detected by DTI was tested during the surgery. And the function of the facial nerve was assessed postoperatively.Results By using DTI,it was found that,the facial nerve of all the cases was at the ventral side of the acoustic neuroma,specifically,it was at the middle part of the acoustic neuroma in 7 cases,at the lower part in 2 cases and at the upper part in 2 cases,all these were the same as those found in the surgery. Ten cases achieved total resection,but 1 case had internal auditory canal tumor residues. Intraoperative facial nerve dynamic EMG monitoring indicated the facial nerve and it＇s position. The facial nerve of all the patients were anatomically preserved in the surgery with a preservation rate of 100%. The results of 1-12-month follow-up showed that,there were 4 cases of House-Brackmann grade Ⅰ,6 cases of grade Ⅱ and 1 case of grade Ⅲ.Conclusion Preoperative FNI via DTI combined with intraoperative electrophysiologic facial nerve monitoring are helpful to locate and protect the facial nerve during surgery,and improve the anatomical and functional preservation rates of the facial nerve in acoustic neuroma surgery.
作者
宋海民
吴至武
冯开明
罗德芳
蒋秋华
SONG Hai - rain WU Zhi-wu FENG Kai-ming LUO De-fang JIANG Qiu-hua(Department of Neurosurgery, Ganzhou Hospital Affiliated to Nanchang University, Ganzhou People＇s Hospital, Ganzhou 314000, China)
出处
《中国全科医学》
CAS
北大核心
2017年第29期3699-3702,共4页
Chinese General Practice
基金
江西省科技厅重点研发计划项目(20161BBG70025)
关键词
神经瘤
听
面神经
弥散磁共振成像
电生理学监测
Neuroma, acoustic
Facial nerve
Diffusion magnetic resonance imaging
Electrophysiologic monitoring
