异常肌肉反应与面神经运动诱发电位监测在面肌痉挛微血管减压术中的应用价值  

The value of abnormal muscle reaction and facial-motor evoked potentials in the microvascular decompression for hemifacial spasm

作　　者：邓大丽[1] 牛朝诗[2] 刘会林[1] 喻廉[1] 李冬雪[2] 丁宛海[2] 姜晓峰[2] 

机构地区：[1]安徽省立医院安徽省脑立体定向神经外科研究所,合肥230001 [2]安徽省立医院神经外科脑功能与脑疾病安徽省重点实验室

出　　处：《中华解剖与临床杂志》2016年第1期42-45,共4页Chinese Journal of Anatomy and Clinics

基　　金：国家临床重点专科项目（2011）;安徽省重点实验室绩效考核补助项目（1306e083028）

摘　　要：目的 探讨电生理监测在微血管减压术（MVD）治疗面肌痉挛中鉴别责任血管、评估减压效果以及判断预后方面的作用。方法回顾性分析2012年6月—2014年5月安徽省立医院神经外科研究所在MVD术中行异常肌肉反应（AMR）和经颅面神经运动诱发电位（Facial—MEP）监测的76例面肌痉挛患者资料，并分别在术后1周和3个月进行疗效评估，比较不同AMR监测结果（消失、波幅下降、无明显变化）患者术后疗效及Facial—MEP监测与早期面神经功能的差异。结果76例患者术中发现单个责任血管60例，多个责任血管16例；患者均记录到典型的AMR波形，术后1周和3个月有效率分别为85．5％（65／76）、92．1％（70／76）。其中AMR消失组的有效率高于AMR波幅下降组，但无论近期还是远期疗效，两组间差异均无统计学意义（P值均〉0．05）；AMR消失组和波幅下降组的近、远期有效率均优于AMR无变化组，差异均有统计学意义（P值均〈0．05）。结论术中AMR监测可辅助判断责任血管，评估减压效果，对患者的预后有重要指导意义。Objective To evaluate the clinic effects of electrophysiological monitoring during the microvascular decompression （MVD） for hemifacial spasm （HFS） . Methods From June 2012 to May 2014, 76 HFS patients were performed with intraoperative abnormal muscle reaction（AMR） and facial-motor evoked potentials（facial-MEP） during MVD. The therapeutic effect was evaluated at 1 week and 3 months postoperation. The relationship between AMR changes and prognosis, Facial-MEP and the postoperative early facial paralysis in monitoring period were analyzed. Results A single offending vascular was found in 60 patients and multiple offending vessels were found in 16 patients. Typical AMR （complete-disappeared, partial-disappeared, non-disappeared） was obsexved in all patients. Relief rate at 1 week and 3 months postoperation was 85.5% （ 65/76 ） and 92. 1% （ 70/76 ）, respectively. Relief rate in AMR-completedisappeared group was higher than that of AMR-partial-disappeared group, but the correlation in the both group was not statistically significant （ all P values 〉 0.05 ）. The therapeutic effect in AMR-completedisappeared group and AMR-partial-disappeared group were significanly better than that in AMR-nondisappeared group （ all P values 〈 0.05）. Conclusions Intraoperative AMR monitoring is helpful in MVD surgery for HFS, which may improve the therapeutic effect.

关 键 词：面部单侧痉挛 微血管减压术 面神经 诱发电位 运动 异常肌肉反应 

分 类 号：R651.3[医药卫生—外科学]