电生理监测在原发性面肌痉挛MVD中的应用  

Clinical value of intraoperative neuroelectrophysiological monitoring in microvascular decompression for patients with primary hemifacial spasm

作　　者：唐思魏 王蕾[2] 陆斌 姜文博 吴国庆[1] TANG Si-wei;WANG Lei;LU Bin;JIANG Wen-bo;WU Guo-qing(Department of Neurosurgery,Qingdao Hospital,University of Health and Rehabilitation Sciences,Qingdao 266071,China)

机构地区：[1]康复大学青岛医院(青岛市市立医院)神经外科,山东青岛266071 [2]康复大学青岛医院(青岛市市立医院)门诊部,山东青岛266071

出　　处：《中国临床神经外科杂志》2023年第12期689-692,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨电生理监测在原发性面肌痉挛(HFS)显微血管减压术(MVD)中的应用价值。方法回顾性分析2012年1月至2022年9月MVD治疗的304例HFS的临床资料。103例(监测组)术中监测侧方扩散波(LSR)、脑干听觉诱发电位(BAEP)和面神经自由肌电图(EMG),201例(对照组)术中未使用电生理监测。术后6个月按照Cohen痉挛强度分级评估疗效;术后1周、6个月记录面瘫、耳鸣、眩晕、听力受损等并发症情况。结果103例中,95例面神经充分减压后,LSR完全消失,7例LSR波幅下降>50%,1例LSR波幅下降不明显;2例BAEP出现Ⅰ波波幅下降>50%,1例出现Ⅲ波潜伏期延长超过20%;61例术中监测到面神经EMG,其中波幅<100μV有54例,100~200μV有7例。术后6个月,监测组有效率(93.03%)与对照组(94.17%)无统计学差异(P>0.05)。术后1周,对照组面瘫(12.43%)、耳鸣(13.43%)、眩晕(20.40%)、听力受损(13.43%)发生率明显高于监测组(分别为4.85%、5.83%11.65%、4.85%;P<0.05)。术后6个月,对照组耳鸣(8.46%)、眩晕(11.44%)、听力受损(9.00%)发生率仍明显高于监测组(分别为1.94%、3.88%、1.94%;P<0.05);但对照组面瘫发生率(3.00%)与监测组(1.00%)无统计学差异(P>0.05)。结论MVD是治疗HFS的有效方法,术中应用神经电生理监测技术,可帮助尽早准确判断责任血管,减少对神经和脑组织的牵拉,减少术后并发症。Objective To investigate the application value of intraoperative electrophysiological monitoring(IEM)in microvascular decompression(MVD)for patients with primary hemifacial spasm(HFS).Methods The clinical data of 304 patients with primary HFS treated with MVD from January 2012 to September 2022 were retrospectively analyzed.Lateral spread response(LSR),brainstem auditory evoked potential(BAEP)and electromyography(EMG)of the facial nerve were performed in 103 patients during the operation(monitoring group),and did not in 201 patients(control group).Six months after operation,the efficacy was evaluated according to Cohen spasm grading.Complications such as facial paralysis,tinnitus,vertigo and hearing loss were recorded 1 week and 6 months after operation.Results LSR disappeared completely after decompression of the facial nerve in 95 patients,LSR amplitude decreased by>50%in 7,and LSR amplitude decreased not significantly in 1.The amplitude of waveⅠof BAEP decreased by more than 50%in 2 patients,and the latency of waveⅢincreased by more than 20%in 1.Facial nerve EMG was detected in 61 patients(amplitude<100μV in 54 patients,100~200μV in 7).There was no significant difference in the effective rate between the monitoring group(93.03%)and the control group(94.17%;P>0.05)6 months after operation.One week after operation,the rates of facial palsy(12.43%),tinnitus(13.43%),vertigo(20.40%)and hearing loss(13.43%)in the control group were significantly higher than those(4.85%,5.83%,11.65%,4.85%,respectively)in the monitoring group(P<0.05).Six months after operation,the rates of tinnitus(8.46%),vertigo(11.44%)and hearing loss(9.00%)in the control group was still significantly higher than those(1.94%,3.88%and 1.94%,respectively)in the monitoring group(P<0.05);however,there was no significant difference in the incidence of facial palsy between the control group(3.00%)and the monitoring group(1.00%;P>0.05).Conclusions MVD is effective for primary HFS.The application of IEM can help to identify the responsible vessels,red

关 键 词：原发性面肌痉挛 显微血管减压术 术中神经电生理监测 疗效 并发症 

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]