肌电图监测技术在颅脑手术中应用.docVIP

肌电图监测技术在颅脑手术中应用 　　【摘要】 目的：总结48例颅脑手术的患者术中肌电图监测面神经功能的临床经验，了解肌电图监测在颅脑手术中的应用价值，降低颅脑手术的风险。方法：选择2013年1月-2016年10月到本院接受颅脑手术治疗的确诊的听神经瘤患者48例，在手术过程中进行了神经电生理的颅神经功能监测，探讨肌电图监测对颅脑手术的重要作用。结果：48例听神经瘤患者中，40例面神经都得到解剖保留，5例患者面神经未进行保留，3例患者面神经不慎断开，进行部分修整后神经端一端吻合且功能也有一定的恢复。肿瘤的全切率为89.58%（43/48），面神经解剖保留率为83.33%（40/48）。48例患者进行术后2周的面神经功能的H-B评分，结果显示Ⅰ级10例，Ⅱ级16例，Ⅲ级13例，Ⅳ级4例，Ⅴ级2例，Ⅵ 级3例；术后9个月面神经功能的H-B评分为Ⅰ级34例，Ⅱ级7例，Ⅲ级3例，Ⅳ级1例，Ⅴ级2例，Ⅵ级1例。结论：通过术中监测自发肌电图结合单极恒压电刺激诱发肌电图可以精确判断面神经的位置，损伤较小，面神经的解剖保留率高，且电刺激可以用于判断面神经预后，可参考性高 【关键词】 肌电图监测； 颅脑手术； 面神经 【Abstract】 Objective：To summarize the clinical experience of intraoperative EMG monitoring of facial nerve function in 48 patients with craniocerebral surgery，to investigate the application value of EMG monitoring in craniocerebral surgery and reduce the risk of craniocerebral surgery.Method：A total of 48 cases undergoing craniocerebral surgery were chosen from January 2013 to October 2016 in our hospitial，the cranial nerve function of neural electrophysiological was monitored.Result：During the 48 cases with acoustic neuroma patients，facial nerve were anatomical reservation in 40 cases， but not retained in 5 patients.Besides，that was accidentally disconnected in another 3 patients partial demaged.Whole cut rate of tumor was 89.58% （43/48），retention rate of facial nerve after dissection was 83.33% （40/48）.48 patients with postoperative facial nerve function were scored by H-B after 2 weeks when finishing surgery，according to the results，10 cases were grade Ⅰ，16 cases were grade Ⅱ，13 cases were grade Ⅲ，4 cases were grade Ⅳ，2 cases were grade Ⅴ，3 cases were grade Ⅵ.Nine months postoperative facial nerve function，H-B grade was also measured，34 cases were grade Ⅰ，7 cases were grade Ⅱ，3 cases were grade Ⅲ，1 case was grade Ⅳ，2 cases were grade Ⅴ，1 case was grade Ⅵ.Conclusion：The intraoperative monitoring of spontaneous EMG combined unipolar constant-voltage stimuli evoke electromyography，which can accurately determine the location of the facial nerve and reduce damage.The