neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2020-22-4-61-73neurosurgery-960Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTТриггерная электромиография в эндоскопической трансназальной хирургии опухолей основания черепаTrigger electromyography in endoscopic transnasal surgery of skull base tumorshttps://orcid.org/0000-0003-3445-3115ШкарубоА. Н.ShkaruboA. N.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4 th Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0002-9789-3452ЧерновИ. В.ChernovI. V.

Илья Валерьевич Чернов

16 4 th Tverskaya-Yamskaya St., Moscow 125047

ichernov@nsi.ruhttps://orcid.org/0000-0003-3595-2696ОгурцоваА. А.OgurtsovaA. A.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4 th Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0001-5473-4905АндреевД. Н.AndreevD. N.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4 th Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0003-1442-5993ДаниловГ. В.DanilovG. V.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4 th Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0001-5010-6661СтрунинаЮ. В.StruninaYu. V.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4 th Tverskaya-Yamskaya St., Moscow 125047

ФГАУ Национальный медицинский исследовательский центр нейрохирургии им. Н.Н. Бурденко Минздрава РоссииРоссияN.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of RussiaRussian Federation2020160120212246173Copyright © Шкарубо А.Н., Чернов И.В., Огурцова А.А., Андреев Д.Н., Данилов Г.В., Струнина Ю.В., 20212021Шкарубо А.Н., Чернов И.В., Огурцова А.А., Андреев Д.Н., Данилов Г.В., Струнина Ю.В.Shkarubo A.N., Chernov I.V., Ogurtsova A.A., Andreev D.N., Danilov G.V., Strunina Y.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/960Введение

Введение. Развитие минимально-инвазивных технологий в последние десятилетия позволило расширить показания к использованию эндоскопических трансназальных транссфеноидальных доступов в хирургии опухолей основания черепа. Стало возможно удалять опухоли основания черепа, распространяющиеся в область прохождения черепных нервов, что сопряжено с риском их повреждения.

Цель исследования — оценка эффективности применения триггерной электромиографии с целью обеспечения анатомической и функциональной сохранности черепных нервов при эндоскопическом трансназальном удалении различных распространенных новообразований основания черепа.

Материалы и методы

Материалы и методы. Проведен статистический анализ и сравнение результатов хирургического лечения 2 групп пациентов с различными опухолями основания черепа. В основную группу включены 30 пациентов, у которых интраоперационно осуществляли триггерную электромиографию для идентификации черепных нервов. В контрольную группу вошли 43 пациента, у которых метод не использовался. Эффективность и безопасность метода интраоперационной идентификации черепных нервов оценивали на основании сравнения базовых характеристик, исходов лечения и факторов, потенциально на них влияющих.

Результаты

Результаты. В основной группе интраоперационно были идентифицированы 57 черепных нервов. Частота радикального удаления оказалась выше в основной группе в 1,6 раза (70 % против 44,2 %, p = 0,03). Отрицательная динамика состояния двигательных черепных нервов после операции чаще наблюдалась в контрольной группе, чем в основной (37,2 % против 13,3 %, p = 0,03), а положительная — в 2,8раза чаще в основной группе, чем в контрольной (37,3 % против 13,9 %, p = 0,08).

Заключение

Заключение. Полученные данные свидетельствуют о том, что интраоперационное использование триггерной электромиографии для идентификации черепных нервов в эндоскопической трансназальной хирургии опухолей основания черепа может положительно влиять на радикальность удаления опухолей и сохранность функции черепных нервов в послеоперационном периоде.

Introduction

Introduction. The development of minimally invasive technologies in recent decades has expanded the indications for the use of endoscopic transnasal transsphenoidal approaches in surgery of skull base tumors. It became possible to perform surgical interventions aimed at removing tumors of the base of the skull that spread to the area of the passage of cranial nerves (cavernous sinus, clival area, cerebello-pontine angle), which is associated with the risk of damage to certain cranial nerves.

The study objective is to evaluate the effectiveness of trigger electromyography in providing anatomical and functional preservation of cranial nerves during endoscopic endonasal transsphenoidal removal of skull base tumors.

Materials and methods

Materials and methods. The study is based on statistical analysis and comparison of the results of surgical treatment of two groups of patients with various tumors of the base of the skull: the main group (30 patients with using trigger electromyography to identify cranial nerves intraoperatively) and the control group (43 patients without using this method). The effectiveness and safety of using the method of intraoperative identification of cranial nerves was evaluated based on a comparison of basic characteristics, treatment outcomes, and factors potentially affecting them.

Results

Results. Fifty-seven (57) cranial nerves were identified intraoperatively in the main group. The frequency of radical removal was 1.6 times higher in the main group (70 % vs 44.2 %, p = 0.03). When analyzing the dynamics of the state of motor cranial nerves after surgery in the main and control groups, it was shown that negative dynamics prevailed in the control group — 37.2 % vs 13.3 % (p = 0.03), and positive dynamics prevailed in the main group (37.3 % vs 13.9 %), 2.8 times (p = 0.08).

Conclusion

Conclusion. The obtained data indicate that the use of the intraoperative identification method in endoscopic transnasal surgery of skull base tumors can positively affect the radical removal of tumors and the preservation of cranial nerve function in the postoperative period.

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The authors declare that there are no conflicts of interest present.