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目的探讨面神经电生理监测下切除大型及巨大听神经瘤技术。方法回顾分析22例大型及巨大听神经瘤临床资料,在面神经电生理监测下行显微手术切除,术后随访面神经功能。结果肿瘤全切除15例,次全切除7例。面神经自发肌电图在面神经受牵拉、挤压、生理盐水冲洗等操作过程中产生显著放电,刺激肌电图对寻找和辨认面神经具有重要作用。面神经位于肿瘤腹下方7例,腹上方2例,腹侧中部13例。所有病例面神经均解剖保留。术后随访6~42个月,面神经功能(House-Brackmann分级),H-B分级Ⅰ级11例,Ⅱ级5例,Ⅲ级2例,Ⅳ级4例。结论面神经电生理监测辅助显微手术对术中解剖与功能保留面神经具有重要价值。
Objective To investigate the technique of excision of large and huge acoustic neuroma under electrophysiological monitoring of the facial nerve. Methods The clinical data of 22 cases of large and giant acoustic neuroma were retrospectively analyzed. The facial nerve electrophysiological monitoring was performed for microsurgical removal and the facial nerve function was followed up. Results 15 cases of total tumor resection, subtotal resection in 7 cases. Facial nerve spontaneous EMG in the facial nerve by pulling, squeezing, saline flushing and other operations have a significant discharge to stimulate the EMG to find and identify the facial nerve plays an important role. The facial nerve is located in the belly of the tumor in 7 cases, in the abdomen in 2 cases, and ventral in 13 cases. Facial nerve was preserved in all cases. The patients were followed up for 6 to 42 months. Facial nerve function (House-Brackmann grade) was classified as grade I in H-B grade 11, grade II in 5, grade III in 2 and grade IV in 4. Conclusion Facial nerve electrophysiological monitoring assisted microsurgery has important value in the anatomy and function of facial nerve preservation.