Wazen J J
Department of Otolaryngology, College of Physicians and Surgeons, Columbia University, New York, NY 10032.
Laryngoscope. 1994 Apr;104(4):446-55. doi: 10.1288/00005537-199404000-00009.
The three different methods of intraoperative monitoring, namely, auditory brainstem response evaluation (ABR), electrocochleography (ECoG), and direct eighth nerve compound action potentials monitoring are reviewed. Both ECoG and direct eighth nerve monitoring surpass the ABR in their ability to provide fast, almost instantaneous, large, reproducible potentials in response to click stimuli. Changes in the amplitude and the latency of these potentials alert the surgeon of an impending eighth nerve injury. Human clinical observations revealed instances of persistence of the ECoG despite a total eighth nerve section in the cerebellopontine angle. Animal and human experiments were conducted to evaluate the effectiveness of ECoG and direct eighth nerve monitoring in hearing preservation. Twelve cats underwent progressive sectioning of the eighth nerve with simultaneous monitoring of changes in their ECoG and direct eighth nerve potentials. ECoG thresholds were obtained intraoperatively in eight patients undergoing surgery for conductive hearing loss. The results of these experiments suggest that recording directly from the eighth nerve is a more accurate technique during cerebellopontine angle and eighth nerve surgery. ECoG, however, appears to have a promising role in the intraoperative monitoring of middle ear reconstruction procedures under general anesthesia.
本文综述了三种不同的术中监测方法，即听性脑干反应评估（ABR）、耳蜗电图（ECoG）和直接第八脑神经复合动作电位监测。ECoG和直接第八脑神经监测在对点击刺激做出反应时，能够提供快速、几乎即时、大且可重复的电位，这一能力超过了ABR。这些电位的幅度和潜伏期的变化会提醒外科医生即将发生第八脑神经损伤。人体临床观察发现，尽管在桥小脑角进行了完全的第八脑神经切断术，但ECoG仍有持续存在的情况。进行了动物和人体实验，以评估ECoG和直接第八脑神经监测在听力保留方面的有效性。对12只猫进行了第八脑神经的渐进性切断，并同时监测其ECoG和直接第八脑神经电位的变化。对8例接受传导性听力损失手术的患者术中获取了ECoG阈值。这些实验结果表明，在桥小脑角和第八脑神经手术中，直接从第八脑神经进行记录是一种更准确的技术。然而，ECoG在全身麻醉下中耳重建手术的术中监测中似乎具有广阔的应用前景。
