摘要：

目的: 评估术中多模态神经电生理监测在经乙状窦后锁孔入路前庭神经鞘瘤切除术中的应用价值。方法: 选择2021年1月至2024年12月在苏州大学附属第二医院首次接受手术治疗的97例原发性前庭神经鞘瘤患者, 根据术中是否出现电生理异常信号分为信号异常组(33例)和信号稳定组(64例), 采用House-Brackmann分级评估术后即刻和术后3个月面神经功能、美国耳鼻咽喉头颈外科学会分级标准结合纯音测听法和言语识别率评估术后即刻和术后3个月听力, 采用单因素和多因素Logistic回归分析筛查术后3个月面神经功能的影响因素。结果: 信号稳定组患者术后面神经功能良好(House-Brackmann分级Ⅰ~Ⅱ级)率于术后即刻[67.19%(43/64)对42.42%(14/33);χ²=5.510, P=0.019]和术后3个月[89.06%(57/64)对66.67%(22/33);χ²=7.226, P=0.007]均高于信号异常组; 听力保留率术后即刻[76.56%(49/64)对48.48%(16/33);χ²=7.765, P=0.005]和术后3个月[75%(48/64)对30.30%(10/33);χ²=18.094, P=0.000]亦高于信号异常组。Logistic回归分析显示, 肿瘤最大径较长(OR=0.792, 95%CI: 0.638~0.983;P=0.035)和电生理信号未恢复(OR=0.016, 95%CI: 0.001~0.313;P=0.006)是术后3个月面神经功能不良的危险因素。结论: 经乙状窦后锁孔入路联合术中多模态神经电生理监测在前庭神经鞘瘤切除术中具有良好的安全性和面神经功能保护效果; 异常电生理信号经干预后恢复患者术后面神经功能良好, 提示"异常信号的可恢复性"对术中操作调整及术后功能预测具有重要价值。

关键词: 神经瘤, 听, 前庭神经, 神经外科手术, 神经电生理监测, 面神经损伤, 听力损失, 危险因素, Logistic模型

Abstract:

Objective: To evaluate the application value of intraoperative multimodal neurophysiological monitoring in vestibular schwannoma resection via the retrosigmoid keyhole approach. Methods: From January 2021 to December 2024, total 97 patients with primary vestibular schwannoma who underwent surgical treatment for the first time in The Second Affiliated Hospital of Soochow University were selected. According to whether intraoperative electrophysiological abnormalities occurred, the patients were divided into the abnormal signal group (n=33) and the stable signal group (n=64). Facial nerve function was evaluated immediately after surgery and at 3 months after surgery using the House-Brackmann (HB) grading. Hearing preservation was assessed immediately after surgery and at 3 months after surgery using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification, combining pure tone audiometry (PTA) and speech recognition score (SRS). Univariate and multivariate Logistic regression analyses were used to analyze the influencing factors of facial nerve function at 3 months after surgery. Results: Compared with the abnormal signal group, the stable signal group had higher rates of good facial nerve function immediately after surgery[67.19% (43/64) vs. 42.42% (14/33); χ²=5.510, P=0.019] and at 3 months after surgery[89.06% (57/64) vs. 66.67% (22/33); χ²=7.226, P=0.007], as well as higher hearing preservation rates immediately after surgery[76.56% (49/64) vs. 48.48% (16/33); χ²=7.765, P=0.005] and at 3 months after surgery[75% (48/64) vs. 30.30% (10/33); χ²=18.094, P=0.000]. Logistic regression analysis showed that tumor maximum diameter (OR=0.792, 95%CI: 0.638-0.983; P=0.035) and unrecovered intraoperative abnormal electrophysiological signals (OR=0.016, 95%CI: 0.001-0.313; P=0.006) were risk factors affecting facial nerve function at 3 months after surgery. Conclusions: The retrosigmoid keyhole approach combined with intraoperative multimodal neurophysiological monitoring has good safety and neural function protective effects in vestibular schwannoma resection. Patients whose electrophysiological signals recovered after intraoperative intervention showed better postoperative neural function, suggesting that the "recoverability" of signals has important value for intraoperative manipulation adjustment and postoperative functional prediction.

Key words: Neuroma, acoustic, Vestibular nerve, Neurosurgical procedures, Neurophysiological monitoring, Facial nerve injuries, Hearing loss, Risk factors, Logistic models

中图分类号: 

• R741

• R651