CAJ | 학술논문

目的：探讨面神经电生理监测下切除大型及巨大听神经瘤技术。方法回顾分析22例大型及巨大听神经瘤临床资料，在面神经电生理监测下行显微手术切除，术后随访面神经功能。结果肿瘤全切除15例，次全切除7例。面神经自发肌电图在面神经受牵拉、挤压、生理盐水冲洗等操作过程中产生显著放电，刺激肌电图对寻找和辨认面神经具有重要作用。面神经位于肿瘤腹下方7例，腹上方2例，腹侧中部13例。所有病例面神经均解剖保留。术后随访6～42个月，面神经功能（ House-Brackmann分级），H-B分级Ⅰ级11例，Ⅱ级5例，Ⅲ级2例，Ⅳ级4例。结论面神经电生理监测辅助显微手术对术中解剖与功能保留面神经具有重要价值。
목적：탐토면신경전생리감측하절제대형급거대은신경류기술。방법회고분석22례대형급거대은신경류림상자료，재면신경전생리감측하행현미수술절제，술후수방면신경공능。결과종류전절제15례，차전절제7례。면신경자발기전도재면신경수견랍、제압、생리염수충세등조작과정중산생현저방전，자격기전도대심조화변인면신경구유중요작용。면신경위우종류복하방7례，복상방2례，복측중부13례。소유병례면신경균해부보류。술후수방6～42개월，면신경공능（ House-Brackmann분급），H-B분급Ⅰ급11례，Ⅱ급5례，Ⅲ급2례，Ⅳ급4례。결론면신경전생리감측보조현미수술대술중해부여공능보류면신경구유중요개치。
Objective To explore the techniques for resection of large and giant vestibular schwannomas under facial nerve monitoring .Methods The data of 22 patients with large and giant vestibular schwannomas underwent the microsurgical resections under facial nerve monitoring were analyzed retrospectivelyy .All patients were followed up and facial nerve function was evaluated .Results Gross total resection was achieved in 15 patients and subtotal in 7.Free-running facial nerve electromyography was elicited while retraction or compressing the FN or irrigating .Stimulated electro-myography was helpful for tracking and identifying the facial nerve .Facial nerve was on the anterior lower third of the tumor in 7 cases, anterior upper third in 2, and anterior middle third in 13.Anato-mical preservation of facial nerve was achieved in all cases .The follow-up from 6 to 42 months postoperatively showed facial nerve function was H-B gradeⅠin 11 cases,gradeⅡin 5,gradeⅢin 2 and gradeⅣin 4. Conclusion Facial neurophysiological monitoring are contributive to preservation of anatomical and functional integrity of facial nerve in microsurgery for large and giant vestibular schwannomas .