术中电生理监测辅助微血管减压术治疗颅神经压迫综合征106例分析  

Microvascular decompression through intraoperation electrophysiological monitoring in 106 patients with brain nerve disease

作　　者：韦永祥[1] 梁维邦[1] 倪红斌[1] 蒋健[1] 刘志坚[1] 

机构地区：[1]南京大学医学院附属南京市鼓楼医院,江苏南京210008

出　　处：《临床神经电生理学杂志》2007年第6期334-337,共4页Journal of Clinical Electroneurophysiology

摘　　要：目的:研究术中脑干听觉诱发电位(BAEP)及面肌旁路传导反应(lateral spread response,LSR)在微血管减压治疗脑神经疾病中的应用价值和意义。方法:本院2005年8月至2007年1月收治三叉神经痛及面肌痉挛病人计106例,全部病人在微血管减压手术全过程中行BAEP及LSR监测。结果:三叉神经痛57例病人中,2例术中出现Ⅰ、Ⅲ波消失,Ⅴ波低平,其中1例术后发生耳鸣,术后两个月康复。所有49例半侧面肌痉挛病人均引出LSR波形,在手术过程的不同阶段LSR反应消失,其中25例在垫入泰氟隆后消失,3例不消失的病人中,有1例在进一步调整泰氟隆位置后LSR消失。LSR消失与术后症状缓解存在一致性。结论:在微血管减压手术治疗面肌痉挛、三叉神经痛等颅神经疾病过程中,联合应用BAEP、LSR等神经电生理技术跟踪手术过程,能够较好地控制听力损伤并发症的发生,判断面神经减压的效果,从而提高手术疗效。Objective： To explore the value of brain stem auditory evoked potential（BAEP） and lateral spread response（LSR） of intraoperation electrophysiological monitoring in microvascular decompression in patients with brain nerve disease. Methods： One hundred and six patients with brain nerve disease （including 57 patients with trigeminal neuralgia and 49 patients with facial hemispasm） were treated with microvascular decompression from August 2005 to January 2007. All operations were tacked with BAEP and LSR. Results： The effective rates for the patients with hemifacial spasm and with trigeminal neuralgia were 94% and 96% respectively. Ⅰ , Ⅲ waves disappeared and Ⅴ waves were low in two patients during operation, one patients suffered hearing impairment and recovered in 2 months after operation . LSR in patients disappeared in different phases of the operation except 3 cases. And the waves of LSR disappeared after Teflon was inserted between nerves and vasculars in 25 of the patients with facial hemispasm LSR of a patients disappeared after position of leflon adjusted and two patients still had LSR at the end of operation. Fellow-up effective treatment was conformity with the disappearance of LSR. Conclusion.. Microvascular decompression through intraoperation electrophysiological monitoring is useful for the avoidance of hearing impairment and the effective treatment of brain nerve neurovascular compression.

关 键 词：微血管减压术 半侧面肌痉挛 三又神经痛 脑千听觉诱发电位 面肌旁路传导反应 (LSR) 

分 类 号：R741.044[医药卫生—神经病学与精神病学]