Seidel Kathleen, Biner Matthias S, Zubak Irena, Rychen Jonathan, Beck Jürgen, Raabe Andreas
Department of Neurosurgery, Inselspital, Bern University Hospital, 3010, Bern, Switzerland.
Department of Neurosurgery, University of Freiburg, Freiburg, Germany.
Neurosurg Rev. 2020 Feb;43(1):241-248. doi: 10.1007/s10143-018-1044-z. Epub 2018 Oct 26.
In vestibular schwannoma (VS) surgery postoperative facial nerve (CN VII) palsy is reducing quality of life. Recently, we have introduced a surgical suction device for continuous dynamic mapping to provide feedback during tumor resection without switching to a separate stimulation probe. The objective was to evaluate the reliability of this method to avoid CN VII injury. Continuous mapping for CN VII was performed in large VS (08/2014 to 11/2017) additionally to standard neurophysiological techniques. A surgical suction-and-mapping probe was used for surgical dissection and continuous monopolar stimulation. Stimulation was performed with 0.05-2 mA intensities (0.3 msec pulse duration, 2.0 Hz). Postoperative CNVII outcome was assessed by the House-Brackmann-Score (HBS) after 1 week and 3 months following surgery. Twenty patients with Koos III (n = 2; 10%) and Koos IV (n = 18; 90%) VS were included. Preoperative HBS was 1 in 19 patients and 2 in 1 patient. Dynamic mapping reliably indicated the facial nerve when resection was close to 5-10 mm. One week after surgery, 7 patients presented with worsening in HBS. At 3 months, 4 patients' facial weakness had resolved and 3 patients (15%) had an impairment of CN VII (HBS 3 and 4). Of the 3 patients, near-total removal was attempted in 2. The continuous dynamic mapping method using an electrified surgical suction device might be a valuable additional tool in surgery of large VS. It provides real-time feedback indicating the presence of the facial nerve within 5-10 mm depending on stimulation intensity and may help in avoiding accidental injury to the nerve.
在前庭神经鞘瘤（VS）手术中，术后面神经（CN VII）麻痹会降低生活质量。最近，我们引入了一种手术吸引装置用于连续动态绘图，以便在肿瘤切除过程中提供反馈，而无需切换到单独的刺激探头。目的是评估该方法避免CN VII损伤的可靠性。除了标准神经生理学技术外，还对大型VS（2014年8月至2017年11月）进行了CN VII的连续绘图。使用手术吸引和绘图探头进行手术解剖和连续单极刺激。刺激强度为0.05 - 2 mA（脉冲持续时间0.3毫秒，频率2.0赫兹）。术后1周和3个月通过House - Brackmann评分（HBS）评估CNVII结果。纳入了20例Koos III级（n = 2；10%）和Koos IV级（n = 18；90%）的VS患者。术前19例患者的HBS为1级，1例为2级。当切除接近5 - 10毫米时，动态绘图可靠地显示了面神经。术后1周，7例患者的HBS恶化。3个月时，4例患者的面部无力得到缓解，3例患者（15%）出现CN VII损伤（HBS 3级和4级）。在这3例患者中，2例尝试进行了近全切除。使用带电手术吸引装置的连续动态绘图方法可能是大型VS手术中有价值的辅助工具。它根据刺激强度在5 - 10毫米范围内提供实时反馈，表明面神经的存在，并可能有助于避免意外损伤神经。
