Hsu J C, Lui T N, Yu C L, Chen Y C, Chang C N, Tan P P
Department of Anesthesiology, Chang Gung Medical College, Chang Gung Memorial Hospital, Taipei, Taiwan R.O.C.
J Formos Med Assoc. 1992 Jun;91(6):580-4.
In six cases of acoustic neurilemmoma, electrocochleogram (ECOchG), brainstem auditory evoked potentials (BAEP) and facial muscle electromyograms (EMG) were recorded to monitor facial nerve and brainstem function. Under isoflurane and nitrous oxide anesthesia, we recorded ECOchG from the tympanic membrane, BAEP from the scalp needle, and facial muscle EMG from the mentalis muscle. During surgery, the body temperature was kept above 36.5 degrees C, and PaCO2 above 30 mmHg. In all cases, the peak N1 of ECOchG and wave I of BAEP had identical latencies throughout the monitoring period. The response was faster and the amplitude was higher in the ECOchG recordings. For calculation of the I-III or I-V interpeak latency of BAEP, the wave I of BAEP could be confirmed more quickly and precisely by the peak N1 of ECOchG. During tumor removal, the embedded facial nerve pathway in the tumor was identified by electric stimulation of the intracranial facial nerve, followed by evoked facial muscle EMG. Facial nerve function was confirmed by nerve traction or direct electric stimulation after total removal of the tumor. No facial palsy or other neurologic sequelae was found after the operations.
对6例听神经鞘瘤患者记录了电耳蜗图（ECOchG）、脑干听觉诱发电位（BAEP）和面部肌肉肌电图（EMG），以监测面神经和脑干功能。在异氟烷和氧化亚氮麻醉下，我们从鼓膜记录ECOchG，从头皮针记录BAEP，从颏肌记录面部肌肉EMG。手术期间，体温保持在36.5℃以上，动脉血二氧化碳分压（PaCO2）保持在30 mmHg以上。在所有病例中，整个监测期间ECOchG的N1峰和BAEP的I波潜伏期相同。ECOchG记录中的反应更快，波幅更高。为计算BAEP的I-III或I-V峰间潜伏期，通过ECOchG的N1峰能更快、更精确地确认BAEP的I波。在肿瘤切除过程中，通过对颅内面神经进行电刺激，随后诱发面部肌肉EMG，来识别肿瘤中包埋的面神经路径。肿瘤完全切除后，通过神经牵拉或直接电刺激确认面神经功能。术后未发现面神经麻痹或其他神经后遗症。
