Application Of Neuroelectrophysiology In Acoustic Neuroma Surgery And Analysis Of Related Factors Affecting Facial Nerve Function

[Objective]Acoustic neuroma is one of the most common benign tumors in intracranial.Surgical resection is one of the most commonly used treatments for acoustic neuroma.At present,with the development of neuroelectrophysiological technology,as the gold standard of neural function localization,neuroelectrophysiological technology has been widely used in neurosurgery.Due to the close anatomical relationship between facial nerve and vestibular nerve,surgical treatment of acoustic neuroma leads to permanent facial nerve function damage in 61-85%of patients[1,2].Intraoperative neuroelectrophysiological monitoring is helpful for accurate location,real-time protection,nerve separation and the integrity of anatomical relationships during the operation.Retrospective analysis of the first affiliated hospital of kunming medical university subject outside nerve in June 2017-June 2018,61 cases of the whole neural electrophysiological monitoring under after sigmoid sinus approach in patients with acoustic neuroma resection,in intraoperative and postoperative facial nerve function assessment,and analyzed the neural electrophysiological technique application in acoustic neuroma surgery and the influence of facial nerve function after surgery for early predictors,reserved for and performer immediate postoperative facial nerve function in patients with early reference.[Methods]A retrospective analysis was conducted on 61 cases of acoustic neuroma resection via retrosigmoid approach under full neurophysiological monitoring from June 2017 to June 2018 in the first Department of Neurosurgery,the First Affiliated Hospital of Kunming Medical University.All the patients were confirmed to be acoustic schwannoma by postoperative pathological results.Statistics include:name,sex,age,course of the disease and tumor size(Koos hierarchical),preoperative facial nerve function classification(House-Backmann hierarchical),postoperative facial nerve function classification(House-Backmann hierarchical),pathological results,neural electrophysiological monitoring results(including Spikes,Bursts,trains A trains,B,C trains),etc.Statistical methods were used to analyze the correlation between the collected data and postoperative facial nerve function,so as to understand the influential factors of facial nerve function retention.[Results]61 intraoperative neural electrophysiological monitoring in patients with acoustic neuroma resection under all 23 cases of the men and women in 38 cases,mean age 47.2+/-9.8 years,the average time duration of 35.0+/-39.3 months,acoustic neuroma Koos size classification:Ⅰ level 0 cases,7 cases Ⅱ,levels Ⅲ 13 cases,Ⅳ 41 cases.Preoperative facial nerve class(House-Backmann hierarchical)Ⅰ36 cases,17 cases Ⅱ,Ⅲ level 4 cases,2 cases Ⅲ,V level in 2 cases,Ⅵ level 0).Intraoperative neural electrophysiological monitoring A Trains in 25 cases,not in 36 cases,postoperative facial nerve class(House-Backmann hierarchical)Ⅰ 25 cases,25 cases,5 cases Ⅲ Ⅱ,Ⅳ level 3 cases,V level 3,Ⅵ level 0.P value>0.05 by chi-square test for gender,age,duration of disease and tumor size was not statistically significant.By chi-square test,preoperative facial nerve function and intraoperative neuroelectrophysiological monitoring of A Trains showed statistically significant P value<0.05.Further logistics regression analysis shows:under the intraoperative neural electrophysiological monitoring does not appear A Trains,preoperative facial nerve function class classification for Ⅳ-Ⅴ patients postoperative facial nerve function class for Ⅰ-Ⅲ probability is 0.319,preoperative facial nerve function in patients with grade class for Ⅰ-Ⅲ,postoperative facial nerve function class for Ⅰ-Ⅲ probability is 0.999,Does not appear A Trains,preoperative facial nerve function class for Ⅰ-Ⅲ postoperative facial nerve function in patients with preserved as likely to appear A Trains,facial nerve function class forⅣ-Ⅴ patients of 3.5 times.[conclusion]1.The appearance of A Trains under preoperative facial nerve function and intraoperative neuroelectrophysiological monitoring is A related factor of postoperative facial nerve function,which has A predictive effect on postoperative facial nerve function.2.Patients with good facial nerve function before surgery are more likely to retain facial nerve function after surgery,and the appearance of A Trains under intraoperative neuroelectrophysiological monitoring may indicate poor facial nerve function after surgery.3.Through the analysis of relevant factors,postoperative facial nerve function can be inferred,which may prompt the surgeon to change the surgical strategy and conduct other adjuvant treatment as soon as possible.