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目的 探讨多道听觉脑干植入的手术方法及其对恢复双侧听神经瘤所致全聋患者听力的效果。方法 7例双侧听神经瘤患者 ,在肿瘤摘除后将 2 1道听觉脑干植入 (auditorybrainstemimplant,ABI)电极植入于第四脑室外侧隐窝内 ,直接刺激脑干耳蜗核 ,术中以面神经电图、舌咽神经肌电图及电诱发听觉脑干反应 (electricallyevokedauditorybrainstemresponses,EABR)确定电极的正确位置。术后 6周开通装置并调试 ,定期行言语识别能力测试。结果 6例患者术中均能准确定位外侧隐窝 ,并能记录到典型的EABR ;术后均能获得不同程度的言语识别能力 ,其中 2例获得开放句识别能力。另 1例患者术中解剖定位困难 ,术中未能记录到EABR。术后电极刺激 1例无非听觉反应、5例部分电极产生非听觉反应、1例全部电极均产生非听觉反应 ,有非听觉反应的相应电极被关闭。结论 多道听觉脑干植入能使因双侧听神经瘤而全聋的患者产生有意义的听觉 ,术中正确定位脑干耳蜗核为手术成功的关键。
Objective To investigate the surgical method of multi-channel auditory brainstem implantation and its effect on the hearing of patients with hearing loss caused by bilateral acoustic neuroma. Methods Seven patients with bilateral acoustic neuroma were treated with 21 auditory brainstem implant (ABI) electrodes implanted in the lateral crypt of the fourth ventricle to directly stimulate the cochlear nucleus of the brain stem. Electrograms, glossopharyngeal nerve electromyography and electrically evoked auditory brainstem responses (EABR) determine the correct location of the electrodes. After 6 weeks of operation, the device was switched on and commissioned, and the speech recognition ability was tested regularly. Results All 6 patients were able to accurately locate the lateral recess during operation and recorded typical EABR. All patients were able to obtain verbal recognition ability in different degrees. Among them, 2 cases obtained open sentence recognition ability. Another patient had difficulty in anatomical positioning during surgery, and EABR could not be recorded during the operation. Postoperative electrode stimuli were non-aural responses in 1 case, non-auditory responses in 5 cases of partial electrodes, non-auditory responses in 1 case of all electrodes, and corresponding electrodes with non-auditory responses were closed. Conclusions Multi-channel auditory brainstem implantation can produce meaningful hearing in patients with bilateral acoustic neuromas. Correct positioning of the brain cochlear nucleus during surgery is the key to success.