经颅电刺激面神经运动诱发电位在小脑脑桥角区肿瘤手术中的应用.pdf

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1、·356·2014年4月第30卷第4期ChinJNeumsurg，April2014，V01．30．周围神经损伤修复．经颅电刺激面神经运动诱发电位在小脑脑桥角区肿瘤手术中的应用马思远乔慧贾桂军贾旺王明然刘莉【摘要】目的探讨静吸复合麻醉下经颅电刺激面神经运动诱发电位(FNMEP)监测在小脑脑桥角(CPA)区肿瘤手术中是否可预测术后面神经功能。方法52例CPA区肿瘤患者，术中行FNMEP监测面神经功能，术后参照H—B面神经分级标准，对术前、后面神经功能的改变和FNMEP波幅术后／术前比率之间的关系进行统计分析。结果FNMEP波幅变化与术后面神经功能差异有统计学意义(P<0．001)。FNMEP波幅

2、比率<50％，预示术后面神经功能障碍；比率>50％，预示术后面神经功能正常或仅为轻度功能障碍(H—BI级或Ⅱ级)。结论FNMEP可预测术后面神经功能，可对现有术中面神经功能的监测技术起到完善、补充的作用。【关键词】面神经；术中监测；运动诱发电位；小脑脑桥角区肿瘤IntraoperativefacialmotorevokedpotentialmonitoringwithtranscranialelectricalstimniationduringcerebellopontineangelareatumorsugeryMaSiyuan，QiaoHui，JiaGuijun，JiaWang，WangM

3、ingran，LiuLi．BeringNeurosurgicalInstitute，CapitalMedicalUniversisy，Be瑶i100050，ChinaCorrespondingauthor：QiaoHui，Email：hqiaol215@sinc~corn【Abstract】objectiveTodeterminewhethermonitoringfacialnervemotor—evokedpotential(FNMEP)elicitedbytranscranialelectricalstimulationduringcerebellopontineangel(CPA)tum

4、orsurgeryisusefulforpredictingpostoperativefacialnerveoutcome．MethodsIn52patientsundergoingCPAtumorsurgery．FNMEPwasdeliveredthroughtranscranialelectricaIstimulation．FNMEPwasrecordedfromtheorismusclesandthementalismuscles．Thecorrelationbetweenthefinal—to—baselineratioand7dayspostoperativefacialnervef

5、unctionwasexamined．PreoperativeandpostoperativefunctionsweredocumentedusingtheHouse—Brackmanngradingsystem．SpearmancorrelationcoefficientswereusedtoevaluatewhetherthepostoperativefacialfuctionwascorrelatedwiththeFNMEPratioinpatientswithCPAtumor．ReslutsThevalidFNMEPswereobtainedin50ofthe52recordingsf

6、romtheorbicularisorismuscleinthegroupofpatientswithCPAtumor,ThepostoperativefacialnervefunctionwascorrelatedsignificantlywithtlleFNMEPratiointheorbicularisorismusclesfP<0．001)．AnFNMEPrateof<50％consistentlypredictedpostoperativefacialpalsy．IftheFNMEPratioremainedat>50％．allpatientshadsatisfactoryfacia

7、lnervefunction(HouseandBrackmanngradesIandII)．Using50％ofbaselineamplitudecriteria．significantfacialdeficitswerepredictedwithasensitivity／specificityof1．00／0．88．ConclusionsIntroperativeFNMEPmonitoringc