耳科学手术用连续面神经刺激钻头。

Continuous facial nerve stimulating burr for otologic surgeries.

机构信息

AP-HP, Hosp Beaujon, ENT Department, Clichy, France.

出版信息

Otol Neurotol. 2011 Oct;32(8):1347-51. doi: 10.1097/MAO.0b013e31822ec097.

DOI:10.1097/MAO.0b013e31822ec097

PMID:21892117

Abstract

OBJECTIVE

To evaluate a continuous facial nerve (FN) stimulating burr (the StimBurGard) during otologic/neurotologic procedures in terms of safety and reliability when drilling in contact with the Fallopian canal (FC) of the mastoid segment of the FN.

STUDY DESIGN

Prospective clinical trial.

SETTING

Tertiary referral center.

PATIENTS

Thirty-five patients operated through translabyrinthine (TL) approach for vestibular schwannoma removal were divided into 3 groups. Group 1 (5 patients): the stimulation current was set at 3 and then at 2 mA visualizing the localization of the burr when the first response at 100-μV threshold was obtained in the mastoid cavity. Group 2 (15 patients): exposure of the FC in the mastoid segment during TL approach was stopped when the first response was obtained at 1-mA stimulation; FC thickness in the second genu and mastoid segment of the FC was evaluated on a postoperative computed tomographic (CT) scan, and FC dehiscence observed on CT scan was compared with surgical observation. Group 3 (15 patients), exposure of the FC was performed as routinely done during a TL approach and surgical observation of FC dehiscence; stimulation values in mA at the 100 μV threshold and FC thickness on postoperative CT scan were evaluated. In all cases, the stimulation value at the cerebellopontine angle root of the FN with a 100-μV response threshold was measured before tumor resection.

RESULTS

Group 1: stimulation at 3 mA occurred in aditus ad antrum and at 2 mA near the FC. Group 2: mean thickness of 1.09 ± 0.69 mm with 2 cases of radiologic dehiscence of the FN. Group 3: the stimulation threshold was 0.6 ± 0.37 mA, and the thickness was 0.41 ± 0.56 mm with 9 cases of uncovered FN (p = 0.0082). In all patients, FN at brainstem was stimulated at 0.03 mA before VS dissection.

CONCLUSION

Continuous FN stimulating burr by means of the StimBurGard system is a safe and effective tool for FN stimulation and identification. The integrity of FC is preserved in most cases when the stimulation intensity is 1 mA.

摘要

目的

在耳神经外科/神经耳科学手术中，评估一种连续面神经（FN）刺激钻头（StimBurGard）在接触乳突段面神经（FN）的鼓索管（FC）时的安全性和可靠性。

研究设计

前瞻性临床试验。

设置

三级转诊中心。

患者

35 例通过经迷路（TL）入路切除前庭神经鞘瘤的患者被分为 3 组。第 1 组（5 例）：当在乳突腔中获得 100-μV 阈值的第一个反应时，刺激电流设置为 3mA，然后设置为 2mA，以可视化钻头的定位。第 2 组（15 例）：在 TL 入路中，当获得 1mA 刺激的第一个反应时，停止暴露乳突段的 FC；在术后 CT 扫描上评估 FC 第二膝和乳突段的厚度，并比较 CT 扫描上观察到的 FC 裂开与手术观察结果。第 3 组（15 例），TL 入路中按常规暴露 FC，并观察 FC 裂开情况；评估术后 CT 扫描时 100μV 阈值的刺激值和 FC 厚度。在所有情况下，在肿瘤切除前，测量小脑桥脑角神经根的 FN 刺激值，阈值为 100μV。

结果

第 1 组：刺激 3mA 发生在乳突窦入口，刺激 2mA 发生在 FC 附近。第 2 组：平均厚度为 1.09±0.69mm，有 2 例 FN 放射性裂开。第 3 组：刺激阈值为 0.6±0.37mA，厚度为 0.41±0.56mm，9 例 FN 未覆盖（p=0.0082）。在所有患者中，在 VS 分离之前，脑干 FN 以 0.03mA 进行刺激。