手術操作に伴う蝸牛神経損傷の発生メカニズム : 走査電顕による研究

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Cochlear nerve injuries caused by surgical manipulation in the cerebellopontine (CP) angle were electrophysiologically and morphologically investigated in dogs. Operative procedures similar to those performed in the CP angle in humans were performed. Lateral-to-medial retraction of the cerebellar hemispheres applied traction force to the cochlear nerve. Brainstem auditory evoked potentials and compound action potentials from the intracranial portions of the cochlear nerves were recorded during the procedures. As a result of the traction force produced by manipulations in the CP angle, the Schwann-glial junctions of the cochlear nerve were separated in some dogs. The exit portions of the cochlear nerve fibers and the branches of the internal auditory artery from the osseous spinallamina were most vulnerable to the traction force derived from such manipulations. The cochlear nerve fibers from the basal turn of the cochlea tended to be easily removed from the tractus spiralis foraminosus at the fundus of the internal auditory canal. This finding may explain occasional occurrence of postoperative high frequency hearing loss among patients who undergo surgical manipulation in the CP angle. In some cases, massive hemorrhage and exudation of plasma were observed in the deep portion of the modiolus, where they compressed the cochlear nerve trunk. This is apparently one of the causes of intraoperative failure of cochlear function. In this study, no correlations between electrophysiological and morphological findings were established.
日本脳神経外科学会の論文
1989-02-15

手術操作に伴う蝸牛神経損傷の発生メカニズム : 走査電顕による研究

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