摘要
目的探讨蜗神经动作电位(cochlear nerve action potential,CNAP)监测在前庭神经鞘瘤手术中的应用及其对听力保护的意义。方法收集2018年4月至2021年12月在解放军总医院神经外科经乙状窦后入路行肿瘤切除的前庭神经鞘瘤患者,术前存在可测听力[美国耳鼻咽喉头颈外科协会(AAO-HNS)分级C级(含)以上],术中实施脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)联合CNAP监测,CNAP监测采用颅内电极持续监测与手持式探头定位监测相结合。按照术后听力是否保留分为听力保留组和听力未保留组,应用SPSS 23.0软件分析比较两组间CNAP及BAEP波形参数的差异。结果共54例患者完成术中监测且资料收集完整,其中男性25例(46.3%)、女性29例(53.7%),年龄27~71岁、平均46.2岁,肿瘤最大直径(18.1±5.9)mm(范围10~34 mm)。肿瘤均全切,术后面神经功能(House-Brackmann分级)Ⅰ~Ⅱ级。54例患者听力保留率为51.9%(28/54)。手术中,切肿瘤前BAEP波形V波引出率为85.2%(46/54),肿瘤切除后听力保留组BAEP波形V波引出率为71.4%(20/28),听力未保留组V波均消失。54例患者术中均可引出CNAP波形,肿瘤切除后两组患者CNAP波形参数具有差异:听力保留组波形为三相波和双相波,而听力未保留组为低平波和正向波;听力保留组肿瘤切除后N1波幅明显高于切肿瘤前[14.45(7.54,33.85)μV比9.13(4.88,23.35)μV,P=0.022],而听力未保留组肿瘤切除后N1波幅较切肿瘤前明显下降[3.07(1.96,4.60)μV比6.55(4.54,9.71)μV,P=0.007];组间比较,肿瘤切除后听力保留组N1波幅明显高于未保留组(P<0.001)。结论BAEP联合CNAP监测有利于术中听力保护,应用定位监测可提示术者避免损伤神经;肿瘤切除后,近脑干端CNAP波形及N1波幅,对预测术后听力保留状态具有一定价值。
Objective To investigate the application of cochlear nerve action potential(CNAP)monitoring in the resection of vestibular schwannoma,especially evaluating its significance for hearing preservation.Methods From April 2018 to December 2021,54 patients with vestibular schwannoma who underwent resection via retrosigmoid approach were collected in Chinese PLA General Hospital.Before surgery,all patients had effective hearing(AAO-HNS grade C or above).Brainstem auditory evoked potential(BAEP)combined with CNAP monitoring was performed during surgery.The CNAP monitoring was combined with continuous monitoring and cochlear nerve mapping.And patients were divided into hearing preservation group and non-preserved group according to postoperative AAO-HNS grade.SPSS 23.0 software was used to analyze the differences of CNAP and BEAP parameters between the two groups.Results A total of 54 patients completed intraoperative monitoring and data collection,including 25 males(46.3%)and 29 females(53.7%),aged 27-71 years with an average age of 46.2 years.The maximum tumor diameter were(18.1±5.9)mm(range 10-34 mm).All tumors were totally removed with preserved facial nerve function(House-Brackmann grade I-II).The hearing preservation rate of 54 patients was 51.9%(28/54).During surgery,the V wave extraction rate of BAEP waveform was 85.2%(46/54)before tumor resection,71.4%(20/28)in the hearing preservation group after tumor resection,and disappeared in the hearing preservation group(0/26).CNAP waveform was elicited in 54 patients during operation.Differences were found in the distribution of CNAP waveforms after tumor resection.The waveforms of the hearing-preserving group were triphasic and biphasic,while those in the non-preserving group were low-level and positive.For hearing preservation group,the amplitude of N1 wave after tumor resection was significantly higher than that before tumor resection[14.45(7.54,33.85)μV vs 9.13(4.88,23.35)μV,P=0.022];However,for the non-preserved group,the amplitude of N1 wave after tumor resectio
作者
王秀英
张军
丛姣
王群
张鼎
Xiuying Wang;Jun Zhang;Jiao Cong;Qun Wang;Ding Zhang(Department of Neurosurgery,Chinese PLA General Hospital,Beijing 100853,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CSCD
北大核心
2023年第3期200-205,共6页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
国家自然科学基金(81971167)
北京市科技计划课题(Z181100001718073)。
关键词
前庭神经鞘瘤
耳蜗神经
动作电位
诱发电位
听觉
脑干
监测
手术中
Vestibular schwannoma
Cochlear nerve
Action potentials
Evoked potentials,auditory,brain stem
Monitoring,intraoperative
