弥散张量成像定位在听神经瘤切除术中的应用及对面神经功能障碍的预防作用
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西安国际医学中心医院

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Application of Diffusion Tensor Imaging in Acoustic Neuroma Resection and Its Preventive Effect on Facial Nerve Dysfunction
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    摘要:

    目的 探究弥散张量成像(DTI)定位在听神经瘤切除术中的应用及对面神经功能障碍的预防作用。方法 选取2017年1月至2020年1月在我院治疗的106例听神经瘤患者,收集患者临床资料。术前通过DTI定位面神经与肿瘤的位置关系,并与术中面神经电生理监测结果进行比较,分析两者检测结果一致性。对患者进行手术,分析手术效果及面神经保留概率以及术后患者面神经功能。结果 面神经均位于肿瘤腹侧,其中位于腹侧前上部者有25例,腹侧中央者有44例,腹侧前下部者有19例,肿瘤上极者有12例,肿瘤下极者有6例。术前DTI结果与术中神经电生理监测结果相符合者有100例,符合概率为94.34%;不符合者有6例,不符合概率为5.66%,差异均不具有统计学意义(P>0.05)。肿瘤手术全切除者有73例,近全切除者有28例,次全切除者有5例,无部分切除患者。患者术后面神经均实现解剖保留。术前面神经功能良好概率为89.62%;术后2周、3个月、6个月以及1年,患者面神经功能良好概率分别为74.53%、46.23%、53.77%以及85.85%;患者术前与术后面神经功能分级差异均具有统计学意义(P<0.05)。结论 术前通过DTI定位面神经位置较准确,且手术效果较好以及面神经保留概率较高,术后患者面神经有一定损伤,术后6个月开始恢复。术前DTI可有效定位面神经与肿瘤的位置关系,指导临床对患者行手术切除肿瘤而解剖保留面神经,降低术后患者面神经功能发生障碍的概率,改善患者预后。

    Abstract:

    Objective Explore the application of diffusion tensor imaging (DTI) positioning in the resection of acoustic neuroma and its preventive effect on facial nerve dysfunction. Methods We selected 106 patients with acoustic neuroma who were treated in our hospital from January 2017 to January 2020, and collected clinical data of the patients. DTI was used to locate the positional relationship between the facial nerve and the tumor before operation, and compared with the intraoperative facial nerve electrophysiological monitoring results to analyze the consistency of the two detection results. Surgery was performed on patients to analyze the effect of surgery, the probability of facial nerve preservation, and the facial nerve function of patients after surgery. Results Facial nerves were located on the ventral side of the tumor, of which 25 cases were located in the upper ventral upper part, 44 cases were located in the central ventral side, 19 cases were located in the lower ventral side, 12 cases were located on the upper pole of the tumor, and 6 cases were located on the lower pole of the tumor. There were 100 cases where the preoperative DTI results were consistent with the intraoperative neuroelectrophysiological monitoring results, and the coincidence probability was 94.34%; There were 6 cases of non-conformity, the probability of non-conformity was 5.66%, and the difference was not statistically significant (P>0.05). There were 73 cases of total tumor resection, 28 cases of near total resection, 5 cases of subtotal resection, and no partial resection. All patients achieved anatomical preservation of the facial nerve after surgery. The probability of good neurological function before surgery was 89.62%; At 2 weeks, 3 months, 6 months, and 1 year after surgery, the probability of good facial nerve function was 74.53%, 46.23%, 53.77%, and 85.85%, respectively; The difference in facial nerve function grading before and after surgery was statistically significant (P<0.05). Conclusion It is more accurate to locate the position of the facial nerve through DTI before operation, and the operation effect is better and the probability of facial nerve preservation is higher. The facial nerve of the patient has a certain degree of injury after the operation, and the recovery begins 6 months after the operation. Preoperative DTI can effectively locate the positional relationship between the facial nerve and the tumor, guide the clinic to surgically remove the tumor while preserving the facial nerve anatomically, reduce the probability of facial nerve dysfunction in the postoperative patient, and improve the prognosis of the patient.

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  • 收稿日期:2022-02-11
  • 最后修改日期:2022-05-07
  • 录用日期:2022-06-10
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