旁路传导通路术中监测在原发性面肌痉挛微血管减压术中的应用(附28例报道及文献复习)  

Intraoperative monitoring of lateral spread response in micro-vascular decompression of primary hemifacial spasm： a report of 28 cases and literature review

作　　者：宋启民[1] 程彦昊[1] 戴超[1] 费昶[1] 王新功[1] 张风华[1] 邵梅[1] 陈春美[2] 李连陵[3] 

机构地区：[1]临沂市人民医院神经外科,276000 [2]福建医科大学附属协和医院神经外科,福州350001 [3]山东大学附属齐鲁医院神经外科,济南250100

出　　处：《中华神经医学杂志》2014年第2期169-172,共4页Chinese Journal of Neuromedicine

基　　金：山东医药卫生科技发展计划青年基金（2011QW008）

摘　　要：目的探讨旁路传导通路术中连续监测在原发性面肌痉挛微血管减压术中的作用。方法选择自2010年1月至2011年5月临沂市人民医院神经外科收治的28例原发性面肌痉挛患者，应用美国EpochXP神经电生理监测设备在微血管减压术中连续刺激面神经颧支．记录眼轮匝肌和颏肌的肌电反应，观察整个手术过程中颏肌异常肌电反应（AMRl变化特点，并进行随访分析。结果随访24个月，本组患者治愈率为89．29％（25／28），有效率为100％，未见复发病例。隔离血管和神经后AMR完全消失22例，术后随访12个月面肌痉挛治愈21例，部分治愈1例。本组患者术中AMR波幅变化与术后随访24个月的临床效果存在相关性（kr=O．627，P=-0．023）。结论旁路传导通路术中连续监测可以在术中实时客观的判断减压效果和估计预后，对提高手术治愈率具有较高的实用价值；AMR波幅下降大于50％也可以预后良好。Objective To explore the value of intraoperative monitoring of lateral spread response （LSR） in microvascular decompression of primary hemifacial spasm. Methods Twenty-eighty patients with primary hemifacial spasm, admitted to our hospital from January 2010 to May 2011, were chosen in our study; they were performed microvascular decompression and U,S EpochXP neurophysiologcal monitoring equipment was used to continuously stimulate the zygomatic branch of facial nerve; the electromyographic response of the orbicularis muscle and mentalis muscle were recorded; the characteristics of abnormal muscle response （AMP,） changes of the mentalis muscle were observed. Follow up was performed on these patients. Results The cure rate was 89.29%, the efficient was 100%, and no recurrence was noted 24 months after follow-up. The abnormal muscle responses of the mentalis muscle disappeared after microvascular decompression of 22 patients; with 12 months of follow up,21 patients were completely free from hemifacial spasm and 1 partly cured. The changes of AMR amplitude and the clinical results at 24 months after follow-up were significantly correlated （kr=0.627, P=0.023）. Conclusions The continuous monitoring of lateral spread response is real-time objective for determining the decompression effect and prognosis. The AMR amplitude not bring completely disappeared can also prognosis good results.

关 键 词：面肌痉挛 术中监测 旁路传导通路 异常肌电反应 微血管减压术 

分 类 号：R651.1[医药卫生—外科学]