Grabb P A, Albright A L, Sclabassi R J, Pollack I F
Division of Pediatric Neurosurgery, University of Alabama at Birmingham, The Children's Hospital of Alabama, Birmingham, Alabama 35233, USA.
Neurosurg Focus. 1996 Aug 15;1(2):e1; discussion 1 p following e1.
The authors reviewed the results of continuous intraoperative electromyographic (EMG) monitoring of muscles innervated by cranial nerves in 17 children whose preoperative imaging studies showed compression or infiltration of the fourth ventricular floor by tumor to determine how intraoperative EMG activity correlated with postoperative cranial nerve morbidity. Bilateral lateral rectus (sixth) and facial (seventh) nerve musculature were monitored in all children. Cranial nerve function was documented immediately postoperatively and at 1 year. Of the 68 nerves monitored, nine new neuropathies occurred in six children (sixth nerve in four children and seventh nerve in five). In five new neuropathies, intraoperative EMG activity could be correlated in one of four sixth nerve injuries and four of five seventh nerve injuries. Electromyographic activity could not be correlated in four children with new neuropathies. Of 59 cranial nerves monitored that remained unchanged, 47 had no EMG activity. Twelve cranial nerves (three sixth nerves and nine seventh nerves) had EMG activity but no deficit. Of four children with lateral rectus EMG activity, three had new seventh nerve injuries. Lateral rectus EMG activity did not predict postoperative abducens injury. The absence of lateral rectus EMG activity did not assure preserved abducens function postoperatively. Likely because of the close apposition of the intrapontine facial nerve to the abducens nucleus, lateral rectus EMG activity was highly predictive of seventh nerve injury. Although facial muscle EMG activity was not an absolute predictor of postoperative facial nerve dysfunction, the presence of facial muscle EMG activity was associated statistically with postoperative facial paresis. The absence of facial muscle EMG activity was rarely associated with facial nerve injury. The authors speculate that EMG activity in the facial muscles may have provided important intraoperative information to the surgeon so as to avoid facial nerve injury.
作者回顾了17例儿童术中连续肌电图（EMG）监测由颅神经支配肌肉的结果，这些儿童术前影像学研究显示肿瘤压迫或浸润第四脑室底部，以确定术中EMG活动与术后颅神经发病率之间的相关性。所有儿童均监测双侧外直肌（第六）和面（第七）神经肌肉组织。术后即刻及1年时记录颅神经功能。在监测的68条神经中，6例儿童出现9例新发神经病变（4例儿童的第六神经和5例儿童的第七神经）。在5例新发神经病变中，术中EMG活动可与4例第六神经损伤中的1例及5例第七神经损伤中的4例相关。4例有新发神经病变的儿童中，EMG活动无法建立相关性。在监测的59条未发生变化的颅神经中，47条无EMG活动。12条颅神经（3条第六神经和9条第七神经）有EMG活动但无功能缺损。在4例有外直肌EMG活动的儿童中，3例有新发第七神经损伤。外直肌EMG活动不能预测术后展神经损伤。外直肌EMG活动缺失并不能保证术后展神经功能保留。可能由于脑桥内面神经与展神经核紧密相邻，外直肌EMG活动高度预测第七神经损伤。虽然面部肌肉EMG活动不是术后面神经功能障碍的绝对预测指标，但面部肌肉EMG活动的存在与术后面瘫在统计学上相关。面部肌肉EMG活动缺失很少与面神经损伤相关。作者推测面部肌肉的EMG活动可能为外科医生提供了重要的术中信息，以避免面神经损伤。
