Discuss Of The Preoperative Localization And Intraoperative Preservation Of The Facial Nerve Using DTI Technique In Patients With Acoustic Neuroma

Object: To track the facial nerve of auditory nerve tumors patients with DTI imaging techniques,and to determine the accuracy of facial nerve preoperative localization and the protect significance of intraoperative facial nerve.Method: The research collected 35 cases with a primary diagnosis of acoustic neuroma in the First Affiliated Hospital of Dalian Medical University,Department of Neurosurgery during January 2014-January 2016,all of them received surgery.All patients underwent routine brain MRI T1 WI,T2WI,enhancement and DTI sequence,and then apply DTI imaging techniques to track the facial nerve.They were all received surgical treatment with sigmoid sinus approach.The surgeon observed the location between the facial nerve and the tumor under the microscope during surgery,intraoperative positioning in front of the nerve DTI imaging results were compared to determine whether the two match.Result:The group of 35 patients,30 patients(85.7%)of the facial nerve before surgery successfully passed the DTI imaging technology to track,in which the facial nerve located above the ventral tumors in 13 cases,8 cases of middle ventral,ventral below 6 cases,the tumor pole 1 case,2 cases of extreme,preoperative and intraoperative tumor were not met in the dorsal nerve Traveling.Preoperative DTI imaging techniques to track the success of the facial nerve of 30 patients were verified facial nerve preoperative localization during surgery,which was 100% fit.Before the huge(diameter 6.6cm)cystic acoustic neuroma patients with facial nerve.1 case the facial nerve which cystic degeneration listen neuroma patient failed tracking technology developed by DTI.4 cases patients with facial paralysis before surgery of facial nerve also failed to track development.The patients intraoperative endoscopic resection of the tumor in 32 cases,endoscopic resection rate of 91.4%.Subtotal resection in 3 cases.The surgery achieve facial nerve anatomy reserved 35 cases,facial nerve anatomical preservation rate was 100%.Postoperative intracranial infection occurred 2 cases,1 case of patients with hydrocephalus.Two weeks after surgery the facial nerve function grading H-B: I 5 cases(14.3%),II grade 17 cases(48.6%),grade III(22.9%),IV in 1 case(11.4%),V 1 case(2.8%),VI grade 0 cases.Hospital discharge GOS rating: 5 points in 29 cases(82.9%),4 points in 5 cases(14.3%),3 points in 1 patient(2.8%),2 points,1 point 0 cases.Conclusions:1.For acoustic neuroma patients,preoperative facial nerve DTI imaging techniques to track the facial nerve is feasible,it can predict the situation in patients’ facial nerve before surgery.But based on the current level of technology and lacking of experience limits,there are still some limitations in technology to imaging track the facial nerve.2.The facial nerve DTI technology and facial nerve intraoperative neurophysiological monitoring in combination for the protection of the facial nerve may be more favorable.