神经电生理监测在原发性面肌痉挛微血管减压术中的应用  

Application of neuroelectrophysiological monitoring in microvascular decompression for primary hemifacial spasm

作　　者：王凤伟 杨金庆[1] 薛勇[1] WANG Feng-wei;YANG Jin-qing;XUE Yong(Department of Neurosurgery,Oilfield General Hospital of Puyang City,Puyang 457001,China)

机构地区：[1]濮阳市油田总医院神经外科

出　　处：《中国临床神经外科杂志》2019年第8期483-485,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨神经电生理监测下微血管减压术治疗原发性面肌痉挛的疗效和安全性。方法回顾性分析2015年10月至2018年10月收治的47例原发性面肌痉挛的临床资料。均经枕下乙状窦后入路神经内镜下进行微血管减压术,25例行脑干听觉诱发电位(BAEP)及侧方扩散效应(LSR)监测(监测组),22例无术中电生理监测(对照组)。47例术后随访3个月。结果监测组术前均引出LSR波;剪开硬脑膜后LSR波消失2例;打开桥小脑角池时LSR波消失1例;垫入Teflon棉片减压后LSR波消失19例,LSR波幅明显下降2例;手术结束后仍不消失1例。术中BAEP监测可见Ⅰ、Ⅲ、Ⅴ波波幅降低,潜伏期延长,以Ⅲ波消失、Ⅴ波波幅下降>50%、潜伏期>1 ms居多。术后2周,监测组和对照组总有效率无统计学差异(100.0%vs.95.5%;P>0.05)。监测组术后并发症发生率(4.0%)明显低于对照组(18.2%;P<0.05)。监测组术后复发率(0%)明显低于对照组(9.1%;P<0.05)。结论原发性面肌痉挛微血管减压术中应用电生理监测,有助于降低并发症发生率及复发率。Objective To investigate the efficacy and safety of microvascular decompression under neuroelectrophysiological monitoring in the treatment of primary facial spasm.Methods The clinical data of 47 patients with primary facial spasm who underwent microvascular decompression through suboccipital retrosigmoid approach from October 2015 to October 2018 were analyzed retrospectively.The introperative neuroelectrophysiological monitorings of brainstem auditory evoked potentials(BAEP)and lateral spread response(LSR)were used in 25 patients(monitoring group)and did not used in 22 patients(control group).Results The LSR waves were induced in all 25 patients before operation,and LSR wave disappeared in 2 after dural incision,disappeared in 1 when cerebellopontine angle cistern was opened,disappeared in 19 after decompression with Teflon cotton sheet,the amplitude decreased significantly in 2 patients,and did not disappear after operation in 1.Intraoperative BAEP monitoring showed that the amplitudes of wavesⅠ,ⅢandⅤdecreased,and the latency of wavesⅠ,ⅢandⅤprolonged.There was no significant difference in the total effective rate between the monitoring and control groups(100.0%vs.95.5%;P>0.05).The incidence of postoperative complications in the monitoring group(4.0%)was significantly lower than that(18.2%)in the control group(P<0.05).The postoperative recurrence rate in the monitoring group(0%)was significantly lower than that(9.1%)in the control group(P<0.05).Conclusion Electrophysiological monitoring during microvascular decompression of primary facial spasm is helpful to reduce the incidence of complications and the recurrence rate.

关 键 词：原发性面肌痉挛 神经电生理监测 微血管减压术 

分 类 号：R745.12[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]