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Cranial nerve monitoring in endoscopic endonasal surgery of skull base tumors (observing of 23 cases)

Chinese Neurosurgical Journal 2019年第1期5卷 21-29页

作者： A.N.Shkarubo I.V.Chernov a.a.ogurtsova V.E.Chernov O.V.Borisov K.V.Koval D.N.Andreev Department of Neurooncology Federal State Autonomous Institution"N.N.Burdenko National Medical Research Center of Neurosurgery"of the Ministry of Health of the Russian FederationMoscowRussia Department of Neurophysiology Federal State Autonomous Institution"N.N.Burdenko National Medical Research Center of Neurosurgery"of the Ministry of Health of the Russian FederationMoscowRussia Department of Neurosurgery N.N.Burdenko Main Military Clinical Hospital of the Ministry of Defense of the Russian FederationMoscowRussia Laboratory of Molecular Human Genetics Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological AgencyMoscowRussia

Background:Preservation of anatomic integrity and function of the cranial nerves during the removal of skull base tumors is one of the most challenging procedures in endoscopic endonasal surgery.It is possible to use intraoperative mapping and identification of the cranial nerves in order to facilitate their preservation.The purpose of this study was to evaluate the effectiveness of intraoperative trigger electromyography in prevention of iatrogenic damage to the cranial nerves.Methods:Twenty three patients with various skull base tumors(chordomas,neuromas,pituitary adenomas,meningiomas,cholesteatomas)underwent mapping and identification of cranial nerves during tumor removal using the endoscopic endonasal approach in Department of Neurooncology of Federal State Autonomous Institution"N.N.Burdenko National Medical Research Center of Neurosurgery"of the Ministry of Health of the Russian Federation from 2013 to 2018.During the surgical interventions,mapping and identification of the cranial nerves were carried out using electromyography in triggered mode.The effectiveness of the method was evaluated based on a comparison with a control group(41 patients).Results:In the main group of patients,44 nerves were examined during surgery using triggered electromyography.During the study,the III,V,VI,VII,and XII cranial nerves were identified intraoperatively.Postoperative cranial nerve deficiency was observed in 5 patients in the study group and in 13 patients in the control group.The average length of hospitalization was 9 days.Conclusion:We did not receive statistically significant data supporting the fact that intraoperative identification of cranial nerves using trigger electromyography reduces the incidence of postoperative complications in the form of cranial nerve deficits(p=0.56),but the odds ratio(0.6)suggests a less frequent occurrence of complications in the study group.Based on our experience,the trigger electromyography methodology appears quite promising and requires further research.

关键词： Electromyography T-EMG Intraoperative cranial nerve identification Endoscopic endonasal approach Skull base tumor surgery

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