Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery
Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery
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DOI：
10.1007/s00701-010-0937-6
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发表时间：
2011-05-01
影响因子：
2.4
通讯作者：
Sato, Hiroaki
中科院分区：
文献类型：
--
作者：
Amano, Midori;Kohno, Michihiro;Sato, Hiroaki
保留面神经功能是听神经瘤手术的重要目标之一。自1997年起，我们已在听神经瘤手术中使用诱发性面神经肌电图（EMG）的术中连续监测。因此，我们调查了手术治疗的患者，以澄清这种监测的有用性，并确定安全标准，为保留面神经functions.This术中连续监测诱发面神经肌电图是一种方法，用于检查在肿瘤切除术中连续直接电刺激诱发的面神经肌电图。这种方法的最大优点是能够真实的识别EMG的变化。我们回顾性研究了216例手术治疗的听神经瘤患者，以确定该监测参数与术后即刻和术后1年面神经功能的相关性，在这些患者中，面神经功能保留率（术后1年House和Brackmann 1或2级）为98.6%，平均肿瘤切除率为98.2%。术后即刻和1年时波幅保留率与面神经功能有显著相关性。为避免严重的面神经麻痹，振幅保留率> 50%的警告标准似乎是有用的。通过术中诱发的面神经肌电图的连续监测，术后面神经功能的过程似乎是可预测的。在听神经瘤手术中，这种监测有助于提高肿瘤切除率，同时避免术后严重的面神经麻痹。
Preservation of facial nerve function is one of the most important goals in acoustic neuroma surgery. We have been using intraoperative continuous monitoring of evoked facial nerve electromyograms (EMGs) since 1997 in acoustic neuroma surgery. We therefore investigated surgically treated patients to clarify the usefulness of this monitoring, and to determine safety criteria for preserving facial nerve function.This intraoperative continuous monitoring of evoked facial nerve EMG is a method for checking the EMG evoked by continuous direct electrical stimulation of the facial nerve during tumor excision. The greatest advantage of this method is the ability to identify changes in EMG in real time. We retrospectively investigated 216 patients with surgically treated acoustic neuroma to identify correlations between parameters in this monitoring and postoperative facial nerve function immediately and 1 year after surgery.In these patients, the functional preservation rate of the facial nerve (House and Brackmann grade 1 or 2 at 1 year after surgery) was 98.6% with a 98.2% mean tumor resection rate. Amplitude preservation ratio correlated significantly with facial nerve function both immediately and 1 year after surgery. To avoid severe facial nerve palsy, a warning criterion of amplitude preservation ratio > 50% appears useful.Postoperative course of facial nerve function appears predictable using intraoperative continuous monitoring of evoked facial nerve EMGs. This monitoring is useful to increase the tumor excision rate while avoiding severe postoperative facial nerve palsy in acoustic neuroma surgery.