摘要：

目的 探讨神经电生理监测在内镜下扩大经鼻蝶海绵窦斜坡区肿瘤切除术中的应用价值。方法 纳入2019年8月至2020年12月在中山大学附属第一医院行内镜下扩大经鼻蝶海绵窦斜坡区肿瘤切除术的18例患者，术中记录上睑提肌、上斜肌、咀嚼肌、眼外直肌自发肌电图（f-EMG）和触发肌电图（t-EMG），评估第Ⅲ~Ⅵ对脑神经（动眼神经、滑车神经、三叉神经和外展神经）功能。结果 18例均顺利完成手术，9例肿瘤全切除、4例次全切除、5例大部切除。术后经病理证实垂体腺瘤10例，脊索瘤5例，颅咽管瘤2例，神经鞘瘤囊性变1例。术中监测动眼神经20条，滑车神经3条，三叉神经27条，外展神经26条。术后平均随访8.63个月，2例出现脑神经功能障碍，脑神经损伤发生率为2/18，并于术后3个月功能恢复正常。结论 内镜下扩大经鼻蝶海绵窦斜坡区肿瘤切除术中监测动眼神经、滑车神经、三叉神经和外展神经安全、有效，通过监测和评估术中f-EMG和t-EMG，可使神经外科医师在肿瘤切除过程中改变手术操作和策略，减少脑神经损伤。

关键词: 脑肿瘤, 海绵窦, 神经内窥镜, 鼻, 蝶窦, 颅神经, 神经电生理监测

Abstract:

Objective To investigate the effect of neurophysiological monitoring in extended endoscopic transsphenoidal surgery for cavernous sinus and clivus tumors. Methods We monitored the oculomotor nerve, trochlear nerve, trigeminal nerve and abducent nerve in 18 patients with cavernous sinus and clivus tumors by recording the free-electromyography (f-EMG) and triggered-electromyography (t-EMG) from August 2019 to December 2020. Two needle electrodes were inserted percutaneous into the levator palpebrae superioris muscle, superior oblique muscle, extraocular rectus muscle and masticatory muscle. To evaluate spontaneous muscle activity and complex muscle action potentials after cranial nerve stimulation. We evaluated the safety of cranial nerves and provided objective information for neurosurgeon. Results All the 18 patients with cavernous sinus and clivus tumors were treated by extended endoscopic transsphenoidal surgery, including 10 pituitary adenomas, 5 chordomas, 2 craniopharyngiomas and one cystic schwannoma. Total resection rate achieved 9/18, subtotal resection rate was 4/18, and partial resection rate was 5/18. There was no postoperative internal carotid artery (ICA) injury and cerebrospinal fluid leakage. A total of 20 oculomotor nerves, 3 trochlear nerves, 27 trigeminal nerves and 26 abducent nerves were recorded. There were one patient with left abducent nerve palsy and one patient with right abducent nerve paresis before surgery. The median follow-up time was 8.63 months, postoperative brain nerve injury occurred in 2 patients, the brain nerve injury rate was 2/18, all of which recovered 3 months after surgery. No patients with postoperative impaired trigeminal nerve function. Conclusions Monitoring of oculomotor nerve, trochlear nerve, trigeminal nerve and abducent nerve in extended endoscopic transsphenoidal surgery for cavernous sinus and clivus tumors is a safe and effective method. By monitoring and evaluating intraoperative f-EMG and t-EMG, neurosurgeons can adjust surgical procedures and strategies during tumor resection and reduce cranial nerve injuries.

Key words: Brain neoplasms, Cavernous sinus, Neuroendoscopes, Nose, Sphenoid sinus, Cranial nerves, Neurophysiological monitoring