神经电生理监测在原发性面肌痉挛显微血管减压术中的应用  

Application of neurolelectrophysiological monitoring in microvascular decompression of primary hemifacial spasm

作　　者：张胜平[1] 王向鹏[1] 李玉[1] 任仲坤[1] 刘孙江 郑家礼 ZHANG Sheng-ping;WANG Xiang-peng;LI Yu(Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China)

机构地区：[1]昆明医科大学第一附属医院神经外一科,昆明650032 [2]昆明医科大学第一附属医院运动医学科,昆明650032

出　　处：《临床神经外科杂志》2021年第1期25-30,共6页Journal of Clinical Neurosurgery

基　　金：云南省运用基础研究(昆医联合专项)[2017FE467(-174)]。

摘　　要：目的探讨神经电生理监测在原发性面肌痉挛微血管减压(MVD)术中的应用价值。方法回顾性分析行显微血管减压手术治疗的241例原发性面肌痉挛患者的临床资料。患者术中均行神经电生理监测,包括异常肌反应(AMR)、脑干听觉诱发电位(BAEP)和面神经自由描记肌电图(Free-EMG)。对神经电生理监测结果与手术疗效及术后并发症进行分析。结果本组患者中218例患者术中AMR消失,其中治愈210例(96.33%)、复发2例(0.84%)、术后并发面神经功能障碍4例(1.69%)。19例患者术中AMR未消失,其中治愈13例(68.42%)、复发4例(21.05%)、并发面神经功能障碍3例(15.79%)。AMR消失组与未消失组患者的治愈率、复发率及术后面神经功能障碍发生率比较,差异均有统计学意义(均P<0.001)。术中BAEP监测,有16例患者发生变化,其中术后发生听力下降者4例(25%)、发生眩晕者11例(68.75%);225例患者BAEP无变化,术后均没有发生听力下降,发生眩晕者23例(10.22%)。BAEP变化组与无变化组患者术后听力下降及眩晕发生率的差异均有统计学意义(均P<0.001)。结论MVD术中进行神经电生理监测可以预测手术效果及评估预后,并对手术操作具有指导意义。Objective To explore the value of neuroelectrophysiological monitoring in microvascular decompression(MVD)of primary hemifacial spasm.Methods The data of 241 patients with primary hemifacial spasm underwent microvascular decompression were analyzed retrospectively.All patients underwent intraoperative neurophysiological monitoring,including abnormal muscle response(AMR),brainstem auditory evoked potential(BAEP)and free electromyography(Free-EMG).The results of electrophysiological monitoring,surgical efficacy and postoperative complications were analyzed.Results AMR disappeared in 218 cases and 210 cases were cured,2 recurred,4 had facial nerve dysfunction,19 with AMR were not disappeared,13 were cured,4 had recurrence and 3 had facial nerve dysfunction.The cure rate and recurrence rate of the two groups were significantly different(P<0.001),the results of facial paralysis were significantly different(P<0.001).There were changes in 16 cases about BAEP,including 4 cases of hearing loss and 11 cases of vertigo,225 of BAEP had no changes,no complications of hearing loss occurred but there was vertigo in 23.There were significant differences in hearing loss and vertigo incidence between the two groups(P<0.001).Conclusions Neuroelectrophysiological monitoring during MVD can predict the outcome and evaluate the prognosis.It has guiding significance and application value for surgery.

关 键 词：面肌痉挛 显微血管减压术 异常肌反应 脑干听觉诱发电位 自由描记肌电图 

分 类 号：R651[医药卫生—外科学]