MEHMET AKDAĞ, Ediz Argün YORGANCILAR, Müzeyyen YILDIRIM BAYLAN

The Use Of Fasial Stımilator in Cochlear implant and Fasial Tumor Surgery

Objective: Our aim in conducting this clinical study that project was to investigate the surgical safety of facial nerve monitoring along with its effects on the duration of the operation in otologic and neurotologic surgery. Methods: We have used intraoperative monitoring and stimulation of facial nerve function routinely in 161 cochlear surgery, and 10 neurotologic cases. Statistical study was performed only in otologic patients. The 171 patients who underwent surgery, of the remaning 30 otologic surgery cases were randomly selected that were monitered. The remaining 30 otologic surgery cases were not monitored and compared statistically for the duration of the operation and the emerging complications. Results: Of the study patients; no responses were detected in seven despite the stimulation. Response occurred only after increasing the amplitude of the stimulation current in two patients. In the remaining 162 patients, the responses were detected. Of the seven patients, in whom no responses were detected; electrode contact was lost in three, nerve fatigue was found in two, and muscle-relaxant use for anesthesia was detected in one patient; while, no causes were identified in one patient. Despite the presence of responses, a transient postoperative paresis was observed in one patient. In cochlear implant patients, the mean duration of surgery was 2.35 hours without monitoring; whereas, it was 1.45 hours in monitored patients. Conclusion: We are of the opinion that this technological method may contribute significantly to obtaining electrophysiologic data, as well as ensuring the safety of the operation and reducing the complication rates.

Koklear İmplant ve Fasiyal Tümör Cerrahisinde Fasiyal Stimilatör Kullanımı

Amaç: Bu klinik proje çalışmamızdaki amacımız; otolojik ve nörotolojik cerrahide fasiyal sinir monitörizasyonunun cerrahi güvenliğini ve operasyonun süresine etkilerini araştırmaktı. Yöntemler: Olgularımızdan toplam171 hastadan 141 hastaya stimulasyon probu kullanılarak moniterize edildi. İstatistik çalışma sadece otolojik hastalarda yapıldı. Otolojik cerrahiden geri kalan 30 hastaya hiç moniterize edilmedi. Bu hastalardan moniterize edilmeyen otolojik 30 hasta ile moniterize edilen ve rastgele seçilen 30 otolojik hasta seçilerek cerrahi süre ve komplikasyon karşılaştırılması yapıldı. Bulgular: Olgularımızda 7 vakada stimilasyon’a rağmen cevap alamama; 2 hastada ise stimilasyon şiddeti artırılarak cevap alınırken diğer tüm 162 hastada cevap alındı. Cevap alınamayan 7 hastada 3 hastada elektrot temassızlığı; 2 hastada sinir yorgunluğu, bir hastada ise anestezi de kullanılan kas gevşeticilerin kullanımı söz konusu iken bir hastada da sebep bulunamadı. Yine bir hastada uyarı alınmasına karşın postoperatif geçici parezi saptandı. Zamansal olarak monitör takılmayan koklear implant hastalarda cerrahi ortalama süresi 2.35 saat sürerken moniterize edilen hastalarda ise bu süre ise 1.45 saat sürdü. Komplikasyon açısından anlamlı fark bulunamadı. Sonuç: Bu teknolojiyi kullanmanın tüm cerrahlar için, gerek elektrofizyolojik veri ve gerekse cerrahi güven ve komplikasyonları azaltma konusunda önemli ve anlamlı destek sağlayabileceğini düşünmekteyiz.

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