Shkarubo Alexey Nikolaevich, Chernov Ilia Valerievich, Ogurtsova Anna Anatolievna, Moshchev Dmitry Aleksandrovich, Lubnin Andrew Jurievich, Andreev Dmitry Nicolaevich, Koval Konstantin Vladimirovich
Department of Neurooncology, N. N. Burdenko Institute of Neurosurgery, Moscow, Russian Federation.
Department of Neurooncology, N. N. Burdenko Institute of Neurosurgery, Moscow, Russian Federation.
World Neurosurg. 2017 Feb;98:230-238. doi: 10.1016/j.wneu.2016.10.089. Epub 2016 Oct 28.
Intraoperative identification of cranial nerves is crucial for safe surgery of skull base tumors. Currently, only a small number of published papers describe the technique of trigger electromyography (t-EMG) in endoscopic endonasal removal of such tumors.
To assess the effectiveness of t-EMG in preventing intraoperative cranial nerve damage in endoscopic endonasal surgery of skull base tumors.
Nine patients were operated on using the endoscopic endonasal approach within a 1-year period. The tumors included large skull base chordomas and trigeminal neurinomas localized in the cavernous sinus. During the surgical process, cranial nerve identification was carried out using monopolar and bipolar t-EMG methods. Assessment of cranial nerve functional activity was conducted both before and after tumor removal.
We mapped 17 nerves in 9 patients. Third, fifth, and sixth cranial nerves were identified intraoperatively. There were no cases of postoperative functional impairment of the mapped cranial nerves. In one case we were unable to get an intraoperative response from the fourth cranial nerve and observed its postoperative transient plegia (the function was normal before surgery).
t-EMG allows surgeons to control the safety of cranial nerves both during and after skull base tumor removal.
术中识别颅神经对于颅底肿瘤的安全手术至关重要。目前，仅有少数已发表的论文描述了触发肌电图（t-EMG）在内镜下经鼻切除此类肿瘤中的应用技术。
评估t-EMG在预防颅底肿瘤内镜下经鼻手术中术中颅神经损伤的有效性。
在1年时间内，对9例患者采用内镜下经鼻入路进行手术。肿瘤包括大型颅底脊索瘤和位于海绵窦的三叉神经鞘瘤。在手术过程中，使用单极和双极t-EMG方法进行颅神经识别。在肿瘤切除前后均对颅神经功能活动进行评估。
我们在9例患者中标记了17条神经。术中识别出了第三、第五和第六颅神经。标记的颅神经术后均未出现功能障碍病例。在1例患者中，我们未获得第四颅神经的术中反应，并观察到其术后短暂性麻痹（术前功能正常）。
t-EMG可使外科医生在颅底肿瘤切除过程中和切除后控制颅神经的安全性。
