Zhang D, Wang X Y, Liu Y Y, Zhang J
Medical School of Chinese PLA, Beijing 100853, China Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Jun 7;58(6):589-595. doi: 10.3760/cma.j.cn115330-20220706-00419.
To explore the value of electrically evoked auditory brainstem response (EABR) monitoring combined with brainstem auditory evoked potential (BAEP) and compound action potential (CAP) monitoring during vestibular schwannoma resection for the protection of the cochlear nerve. Clinical data from 12 patients with vestibular schwannomas who had useful hearing prior to surgery were analyzed at the PLA General Hospital from January to December 2021. Among them, there were 7 males and 5 females, ranging in age from 25 to 59 years. Before surgery, patients underwent audiology assessments (including pure tone audiometry, speech recognition rate, etc.), facial nerve function evaluation, and cranial MRI. They then underwent vestibular schwannoma resection via the retrosigmoid approach. EABR, BAEP, and CAP were simultaneously monitored during surgery, and patients' hearing preservation was observed and analyzed after surgery. Prior to surgery, the average PTA threshold of the 12 patients ranged from11 to 49 dBHL, with a SDS of 80% to 100%. Six patients had grade A hearing, and six patients had grade B hearing. All 12 patients had House-Brackman grade I facial nerve function prior to surgery. The MRI indicated tumor diameters between 1.1 and 2.4 cm. Complete removal was achieved in 10/12 patients, while near-total removal was achieved in 2/12 patients. There were no serious complications at the one-month follow-up after surgery. At the three-month follow-up, all 12 patients had House-Brackman grade I or II facial nerve function. Under EABR with CAP and BAEP monitoring, successful preservation of the cochlear nerve was achieved in six of ten patients (2 with grade B hearing, 3 with grade C hearing, and 1 with grade D hearing). Successful preservation of the cochlear nerve was not achieved in another four patients (all with grade D hearing). In two patients, EABR monitoring was unsuccessful due to interference signals; however, Grade C or higher hearing was successfully preserved under BAEP and CAP monitoring. The application of EABR monitoring combined with BAEP and CAP monitoring during vestibular schwannoma resection can help improve postoperative preservation of the cochlear nerve and hearing.
探讨电诱发听性脑干反应（EABR）监测联合脑干听觉诱发电位（BAEP）和复合动作电位（CAP）监测在前庭神经鞘瘤切除术中对耳蜗神经的保护作用。分析2021年1月至12月解放军总医院12例术前有有效听力的前庭神经鞘瘤患者的临床资料。其中男性7例，女性5例，年龄25至59岁。术前患者接受了听力学评估（包括纯音听力测定、言语识别率等）、面神经功能评估和头颅MRI检查。然后通过乙状窦后入路进行前庭神经鞘瘤切除术。术中同时监测EABR、BAEP和CAP，并对术后患者的听力保留情况进行观察和分析。术前，12例患者的平均PTA阈值为11至49 dBHL，SDS为80%至100%。6例患者为A级听力，6例患者为B级听力。所有12例患者术前面神经功能均为House-Brackman I级。MRI显示肿瘤直径在1.1至2.4 cm之间。12例患者中10例实现了完全切除，2例实现了近全切除。术后1个月随访无严重并发症。在3个月随访时，所有12例患者的面神经功能均为House-Brackman I级或II级。在EABR联合CAP和BAEP监测下，10例患者中有6例成功保留了耳蜗神经（2例为B级听力，3例为C级听力，1例为D级听力）。另外4例患者（均为D级听力）未成功保留耳蜗神经。2例患者因干扰信号导致EABR监测失败；然而，在BAEP和CAP监测下成功保留了C级或更高水平的听力。在前庭神经鞘瘤切除术中应用EABR监测联合BAEP和CAP监测有助于提高术后耳蜗神经保留率和听力。
