不同刺激强度下的异常肌反应对面肌痉挛显微血管减压术中操作的指导意义  

Significance of abnormal muscle response under different stimulation intensity during microvascular decompression for patients with primary facial spasm

作　　者：任坚锋 赵永斌 田杨 李爱仙 高菁 许金诚 王志琴 栾国明[2] 任杰[2] REN Jian-feng;ZHAO Yong-bin;TIAN Yang;LI Ai-xian;GAO Jing;XU Jin-cheng;WANG Zhi-qin;LUAN Guo-ming;REN Jie(Department of Neurosurgery,Kunming Sanbo Brain Hospital,Kunming 650010,China;Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China;Department of Neurosurgery,Xi'an Trade Union Hospital,Xi'an 710100,China)

机构地区：[1]昆明三博脑科医院神经外科,昆明650010 [2]首都医科大学三博脑科医院神经外科,北京100093 [3]西安工会医院神经外科,西安710100

出　　处：《中国临床神经外科杂志》2023年第10期632-634,638,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨不同刺激强度下诱发的异常肌反应(AMR)对面肌痉挛(HFS)显微血管减压术(MVD)的指导意义。方法回顾性分析2020年9月至2021年12月在AMR指导下MVD治疗的53例HFS的临床资料。术中处理血管后,刺激强度增加到100 mA时,AMR消失,表明减压充分,结束手术;如AMR未消失,则继续对面神经颅内段及其出脑干区进一步探查,对可疑因素进一步处理,若未发现可疑因素,则结束手术。结果53例在麻醉完成后、手术开始前均稳定出现AMR。术中38例AMR消失后增加刺激强度到100 mA,AMR始终未出现;13例AMR消失后刺激强度增加到50~70 mA时AMR重新出现,进行相关操作后AMR消失,刺激强度增加到100 mA,AMR未出现。52例(98.11%)术后即刻症状消失;1例(1.89%)出院时面部有轻微抽动症状,出院后随访2个月,症状消失。术后并发症包括轻、中度面瘫5例、听力减退2例、脑脊液漏合并颅内感染2例,均治愈。结论MVD中应用较低的刺激强度(<30 mA)诱导的AMR消失时,增加刺激强度,部分病人的AMR可再次出现。这可进一步指导发现面神经根部的动脉细小分支或蛛网膜小梁等可能导致HFS延迟治愈或未治愈的相关影响因素。Objective To explore the guiding significance of abnormal muscle response(AMR)induced by different stimulation intensity during microvascular decompression(MVD)for patients with hemifacial spasm(HFS).Methods The clinical data of 53 patients with HFS who were treated with MVD under the guidance of AMR from September 2020 to December 2021 were retrospectively analyzed.After intraoperative vascular decompression,further operation was performed according to the AMR induced by the stimulation intensity of 100 mA.Results AMR was stable in all patients after anesthesia and before operation.AMR disappeared in 38 patients after vascular decompression when the stimulation intensity was increased to 100 mA,and AMR reappeared in 13 patients when the stimulus intensity increased to 50-70 mA after AMR disappeared.Fifty-two patients(98.11%)had no facial twitch symptom immediately after surgery,and 1(1.89%)had slight facial twitch symptom at discharge,which was disappeared after 2 months follow-up.Mild and moderate facial paralysis occurred in 5 patients,hearing loss in 2,and cerebrospinal fluid leakage combined with intracranial infection in 2 after operation.Conclusions When the AMR induced by the lower stimulation intensity(<30 mA)disappeared during MVD for patients with HFS,AMR can reappear in some patients when the stimulation intensity increases to 100 mA.This can further guide to discover the small branch of the artery at the root of the facial nerve or the arachnoid trabecula and other related influencing factors that may lead to delayed or non-cured HFS.

关 键 词：面肌痉挛 显微血管减压术 异常肌反应 

分 类 号：R651.3[医药卫生—外科学]