Roberson J, Senne A, Brackmann D, Hitselberger W E, Saunders J
California Ear Institute at Stanford, Palo Alto, USA.
Am J Otol. 1996 Jul;17(4):653-7.
A new application of auditory evoked potentials using direct cochlear nerve action potentials (CNAPs) for monitoring middle fossa acoustic neuroma resection with attempted hearing preservation is described. Twenty patients have been studied to date. With this technique, a monitoring electrode is secured between the floor of the internal auditory canal and the dura adjacent to the cochlear nerve in an extradural location. Standard auditory evoked potential techniques with click stimuli and microelectrical recording allow observation of nearfield waveforms in seconds versus several minutes required for farfield potentials recorded from the scalp. Advantages of this technique over auditory brainstem response monitoring may include nearly real time measurement of potentials, improved surgeon learning curve and possibly higher rates of hearing preservation, and applicability to all patients undergoing hearing-preservation surgery independent of presence or absence of ABR tracing. Immediate changes in amplitude and latency of waveforms appear to compare with reversible and irreversible intraoperative auditory system damage, thereby guiding surgical maneuvers.
本文描述了听觉诱发电位的一种新应用，即利用直接蜗神经动作电位（CNAPs）监测试图保留听力的中颅窝听神经瘤切除术。迄今为止，已对20例患者进行了研究。采用该技术时，将监测电极固定在硬脑膜外，位于内耳道底部与蜗神经相邻的硬脑膜之间。使用短声刺激和微电记录的标准听觉诱发电位技术，可在数秒内观察到近场波形，而从头皮记录远场电位则需要几分钟。该技术相对于听觉脑干反应监测的优势可能包括电位的近实时测量、改善外科医生的学习曲线以及可能更高的听力保留率，并且适用于所有接受听力保留手术的患者，无论是否有听觉脑干反应描记。波形幅度和潜伏期的即时变化似乎与术中听觉系统的可逆性和不可逆性损伤相关，从而指导手术操作。
