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目的:探讨颞骨岩部胆脂瘤术中面神经监测与减压的临床效果。方法:11例颞骨岩部胆脂瘤患者均伴有面瘫,经颅中窝-乳突联合进路行胆脂瘤切除术,其中8例鼓膜穿孔或中耳乳突感染者行乳突腔开放术式;3例岩尖并侵犯中耳乳突但鼓膜完整者行外耳道关闭术式。术中应用神经监护仪行面神经完整性监护,完成颞骨内面神经减压术。面神经功能评价参照House-Brackmann标准。结果:随访3~12个月,11例面神经功能逐渐恢复,1例面瘫恢复到基本正常,9例恢复到轻度,1例恢复到轻中度,均无胆脂瘤复发。结论:颅中窝-乳突联合进路切除颞骨岩部胆脂瘤同期行面神经减压术疗效满意,神经完整性监护有助于术中面神经定位和保护。
Objective: To investigate the clinical effect of facial nerve monitoring and decompression in the treatment of cholesteatoma of the temporal bone rock. Methods: Eleven patients with temporal bone rock cholesteatoma were accompanied by facial paralysis and cholecystectomy through the middle cranial fossa-mastoid process. Among them, 8 cases of tympanic membrane perforation or middle ear mastoidosis were treated with mastoid open ; 3 cases of rock tip and violations of the middle ear mastoid but tympanic membrane external auditory canal closed surgery. Intraoperative nerve monitor facial nerve integrity monitoring, the completion of the temporal bone decompression. Facial nerve function evaluation reference House-Brackmann standard. Results: During the follow-up period of 3 to 12 months, facial nerve function gradually recovered in 11 cases, facial paralysis in 1 case returned to normal, 9 cases recovered to mild, and 1 case returned to mild to moderate degree without recurrence of cholesteatoma. CONCLUSIONS: The middle cranial fossa-mastoid process combined with resection of the cholecystolithiasis in the temporal petrosal bone is satisfactory in the same period with facial nerve decompression. The neurointegration monitoring is helpful for intraoperative facial nerve positioning and protection.