肌电图监测在听神经瘤手术中的应用

Application of electromyographic monitoring in acoustic neuroma surgery

摘要:

目的 探讨肌电图监测在听神经瘤手术中的应用。方法 收集2016年1月至2017年12月收治的听神经瘤患者术中记录的口轮匝肌和眼轮匝肌的针状电极肌电图（electromyography，EMG）资料，分析术中A trains等自发肌电反应（spontaneous muscle activity，SMA）对术后面神经功能状态的预测作用。结果 61例患者进行了面神经SMA监测，面神经均得到解剖保留。其中53例监测到SMA，33例患者的SMA中出现了A trains，20例患者出现其他形式的SMA。两组患者术后1周面神经功能损伤分别为21例和7例，短期面神经功能损伤差异有统计学意义（P=0.043<0.05），术后1年面神经功能损伤患者分别为16例和5例，长期面神经功能损伤差异没有统计学意义（P=0.090>0.05）。结论 术中SMA能够帮助术者定位面神经及减少其医源性损伤；A trains较其他SMA类型在评估术后短期（1周）面神经功能损伤方面具有意义，评估术后长期（1年）面神经功能损伤无意义。

Abstract:

Objective To explore the application of electromyographic monitoring in acoustic neuroma surgery.Methods Electromyographic data of the orbicularis oculi and orbicularis oris recorded during surgery using needle electrodes were collected from acoustic neuroma patients admitted from January 2016 to December 2017. The prediction of facial nerve function after surgery by spontaneous muscle activity (SMA) such as A trains was analyzed.Results Sixty-one patients underwent monitoring of SMA in the facial nerve. The anatomy of the facial nerve was preserved during surgery. In those patients, 53 had SMA detected, consisting of 33 with A trains and 20 with other types of SMA. In the two groups of patients, 21 and 7 patients had facial nerve function injury one week after surgery, suggesting a significant difference in short-term facial nerve function injury between the two groups (P=0.043); 16 and 5 patients underwent facial nerve function injury one year after surgery, suggesting that there was no significant difference in long-term facial nerve function injury between the two groups (P=0.090).Conclusions Monitoring SMA during surgery can help surgeons locate the facial nerve and reduce its iatrogenic injury. Compared with other types of SMA, A trains has a significant value in predicting short-term (1 week) facial nerve function injury after surgery but not in predicting long-term (1 year) facial nerve function injury after surgery.