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  • Title: [Preliminary application of combined auditory monitoring technique in resection of vestibular neurinoma].
    Author: Zhang D, Wang XY, Liu YY, Zhang J.
    Journal: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi; 2023 Jun 07; 58(6):589-595. PubMed ID: 37339899.
    Abstract:
    Objective: 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. Methods: 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. Results: 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. Conclusion: 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. 目的： 探讨前庭神经鞘瘤切除术中电诱发听性脑干反应（electrcally evoked auditory brainstem response，EABR）监测联合脑干听觉诱发电位（brainstem auditory evoked potential，BAEP）和蜗神经复合动作电位（compound action potential，CAP）监测对保护耳蜗神经的价值。 方法： 分析2021年1—12月解放军总医院12例术前存在可用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25~59岁。患者术前行听力学（包括纯音测听、言语识别率等）、面神经功能评估、颅脑MRI等检查，经乙状窦后入路行前庭神经鞘瘤切除术，术中进行EABR、BAEP、CAP联合监测，术后观察分析患者听力保留情况。 结果： 12例患者术前纯音平均听阈11~49 dBHL，言语识别率80%~100%；术前美国耳鼻咽喉头颈外科协会（AAO-HNS）听力分级A级6例，B级6例。术前面神经功能均为House-Brackman分级（HB分级）Ⅰ级。MRI提示肿瘤直径1.1~2.4 cm。10例（10/12）患者肿瘤达到完全切除，2例（2/12）患者肿瘤近全切除。术后随访1个月，未发现严重并发症。术后随访3个月，12例患者面神经功能均为HB Ⅰ级或Ⅱ级。在EABR联合CAP、BAEP技术监测下，6例（6/10）患者成功实现蜗神经的解剖保留，其中B级听力2例、C级3例、D级1例；其余4例（4/10）未能实现蜗神经的解剖保留，术后听力均为D级。2例患者术中因出现干扰信号未能成功进行EABR监测，但在BAEP及CAP联合监测下也成功保留了C级（含）以上听力。 结论： 前庭神经鞘瘤切除术中联合应用EABR、BAEP和CAP监测，有助于提高患者术后蜗神经解剖及听力保留率。.
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