电生理监测在面肌痉挛微血管减压术中的作用

目的 评价异常肌反应(Abnormal muscle response,AMR)监测在面肌痉挛微血管减压术(Microvascular decompression,MVD)中的作用.方法 回顾性分析在我科接受治疗的241例典型面肌痉挛患者临床资料并检索数据库中关于AMR监测与面肌痉挛MVD手术疗效关系的临床研究文章,采用RevMan 5.1荟萃分析软件进行分析,对AMR变化程度与术后疗效关系采用优势比(Odds ratio,OR)进行评价.结果 A组(AMR完全消失或波幅下降超过80％),B组的手术有效率分别为96.2％,82.1％,组间差异具有统计学意义(P＜0.05);荟萃分析显示AMR消失组的术后治愈率是AMR未消失组的3.53倍[OR=3.53,95％置信区间95％CI(2.28,5.48)].结论 面肌痉李微血管减压术中行AMR监测可有效指导手术,提高手术治愈率,应将AMR作为MVD术中常规监测项目.     

异常肌反应在面肌痉挛显微血管减压术中的应用研究

目的探讨异常肌反应(AMR)在面肌痉挛(HFS)微血管减压(MVD)术中的应用价值。方法对124例面肌痉挛MVD术治疗患者在术前及术后进行AMR监测;并分析术后AMR是否消失与手术效果的关系。结果MVD术后,本组患者中有92例患者的AMR消失,30例患者AMR持续存在。AMR消失组患者的术后即刻治愈率(87.0%)显著高于AMR未消失组(66.7%)(P=0.026);而两组患者的术后远期治愈率则无显著差异(P>0.05)。两组患者并发症的发生率亦无显著差异。结论面肌痉挛MVD术后AMR消失患者的即刻治愈率较高。但术后AMR持续存在并不代表治疗效果不良,AMR消失与否与面肌痉挛患者的远期效果没有明显关系;而AMR持续存在的患者可能面临着较高的延迟治愈发生率。     

面肌痉挛微血管减压术中电生理监测价值研究

目的通过荟萃分析对异常肌反应(AMR)监测在面肌痉挛(HFS)微血管减压手术(MVD)中的作用进行评价。方法回顾性分析在我科接受治疗的33例典型面肌痉挛患者临床资料,计算机检索数据库中关于AMR监测与面肌痉挛MVD术后疗效关系的临床研究,采用Rev Man5.3荟萃分析软件进行分析,采用优势比(OR)对术中AMR变化程度与术后疗效的关系进行评价。结果AMR消失组,显著变化组,未消失组的手术有效率分别为96.6%,50%,50%,组间差异具有统计学意义(P0.05);荟萃分析显示AMR消失组的术后治愈率是AMR未消失组的2.94倍[OR=2.94,95%CI为(2.03~4.27)]。结论在面肌痉挛微血管减压术中进行AMR监测可有效提高手术治愈率,应将AMR作为面肌痉挛MVD术中常规电生理监测项目。     

异常肌反应监测在面肌痉挛显微血管减压术中的应用

目的探讨术中异常肌反应在原发性面肌痉挛微血管减压术中的价值及评估患者预后疗效的作用。方法回顾性分析我科2015年1月至4月收治的41例患者进行术中异常肌电反应监测(AMR),根据术中AMR波有无消失对术中减压效果进行评判,并随访1个月,将术中AMR波消失组与未消失组治愈率进行对比。结果41例患者中手术结束时AMR波未消失11例,术后1个月随访,5例停止抽搐,6例面部仍间断抽搐,其中2例未见明显减轻,治愈率为45.5%;AMR波消失30例,术后1个月随访,26例停止抽搐,4例仍间断抽搐,但较术前明显减轻,治愈率为86.7%。AMR波消失组的治愈率明显高于未消失组,两组间比较有显著差异(P0.05)。结论面肌痉挛微血管减压术中行异常肌反应监测能够评估患者预后,提高近期治愈率,降低术后延迟治愈的发生率。     

显微血管减压术治疗面肌痉挛后出现延迟治愈的相关因素分析

目的探讨显微血管减压术(MVD)治疗面肌痉挛(HFS)术后延迟治愈的相关因素。方法回顾性分析行MVD治疗的415例HFS病人的临床资料,统计分析延迟治愈的相关因素。结果术后出现延迟治愈106例(25.5%),症状持续7 d～8个月后完全消失。延迟治愈的发生与病人性别、年龄、术中血管压迫情况无关(均P0.05);与病史长短、术前症状严重程度、动脉硬化及异常面肌反应(AMR)有关(均P0.05)。术前病史长短对延迟治愈持续时间影响最大,且二者呈一定正相关性(r=0.77,P0.01)。结论延迟治愈为MVD治疗HFS术后较为常见的现象,发生原因尚不明确,术后病人应持续随访1年以上再进行疗效评价。     

异常肌反应变化在面神经微血管减压术中的应用

目的 探讨异常肌反应(AMR)监测在面神经微血管减压术(MVD)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 305例典型面肌痉挛患者接受了面神经MVD术中AMR的实时监测,并分别在术后1 d、1个月和3个月进行疗效评估,分析术中AMR变化与手术预后之间的关系.结果 所有患者均在术中记录到典型AMR波形,术后1 d、1个月和3个月症状缓解率分别为89.8%、93.8%、94.8%.术中监测AMR消失组和AMR显著变化组的疗效明显好于AMR未消失组(P<0.05).结论 术中AMR监测可辅助判断责任血管,评估减压效果,对提高手术疗效具有较高的应用价值.     

神经电生理监测异常肌反应在面肌痉挛术中的作用

目的 评价异常肌反应（AMR）监测在面肌痉挛微血管减压术（MVD）中的应用价值。方法 2011年4月至2013年7月收治的88例面肌痉挛患者,均行MVD治疗,采用神经电生理监测AMR波指导手术。结果 术前所有患者均监测到AMR波,压迫面神经的血管减压后76例（86.4%）AMR波消失,12例（13.7%）AMR波未消失。术后随访结果6个月,AMR波消失的76例患者中,75例面肌痉挛消失,1例痉挛程度较术前明显缓解;AMR波未消失的12例患者,8例面肌痉挛消失,3例较术前明显缓解,1例无效。结论 面肌痉挛患者MVD术中监测AMR波有助于鉴别责任血管、评价手术减压效果、判断手术后患者的预后。     

异常肌反应在面神经显微血管减压术中的应用

目的 探讨异常肌反应(abnormal muscle response,AMR)监测在面神经显微血管减压术(microvascular decolnpression,MVD)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 241例典型面肌痉挛患者接受了面神经MVD术中AMR的实时监测,并在术后1周进行疗效评估,分析术中AMR变化与手术预后之问的关系.结果 所有241例患者均在术中记录到典型AMR波形,术后第1周217例(90.0%)患者症状完全缓解.AMR消失组175例,其中165例(94.3%)症状缓解;AMR未消失组66例,52例(78 8%)症状缓解.统计学分析显示AMR消失组的疗效明显好于AMR未消失组(P<0.05).结论 术中AMR监测可辅助判断责任血管,评估减压效果,对提高手术疗效具有较高的应用价值.

Abstract：

Objective Abnormal muscle response( AMR) to the electrical stimulation of a branch of facial nerve is a specific electrophysiological feature of primary hemifacial spasm ( HFS) .Although the correlation between intraoperative AMR findings and postoperative results in patients with HFS has been investigated before, the AMR monitoring has not been employed widely during the microvascular decompression (MVD) surgery.The aim of this study was to evaluate the value of AMR monitoring during MVD, and the correlation between the AMR changes and the clinical outcome.Method This study included 241 cases of MVD.Intraoperative AMR monitoring was performed for each subject.The patients were divided into two groups based on whether the AMR wave disappeared or not following decompression of the facial nerve.Results The AMR disappeared after MVD in 175 patients.Among these 175 patients, 165(94.3% ) patients were relieved from HFS 1 week after HFS.Out of the 66 patients in whom the AMR persisted after MVD, 52(78.8%) patients were relieved.The correlation between intraoperative AMR abolition and HFS relief was statistically significant ( P < 0.05 ) .Conclusions Intraoperative AMR monitoring is an effective assistant for a successful MVD for the patient with HFS.It may be helpful in predicting outcomes in short term and identifying offending vessels,so it should be monitored routinely during MVD.     

侧方扩散波在原发性面肌痉挛微血管减压手术中的意义

目的探讨侧方扩散波在原发性面肌痉挛微血管减压手术中的意义。方法将60例原发性面肌痉挛患者分为A组和B组,A组为实施常规枕下乙状窦后入路微血管减压术,B组为常规手术中在判断责任血管垫入垫棉时使用术中电生理监测,指导手术。比较两组术后一周治愈率;将B组中病人分为LSR消失组和LSR未消失组,比较术后一周治愈率。将LSR消失组分为眼轮匝肌LSR消失组,颏肌LSR消失组和眼轮匝肌和颏肌LSR同时消失组,比较各组术后一周治愈率。结果 A组中19例治愈率63.33%。B组中26例治愈率86.67%。两组间治愈率差异具有统计学意义(χ~2=4.356,P=0.037,P0.05)。B组23例侧方扩散波消失病例中22例治愈,治愈率95.65%;7例侧方扩散波未消失中4例治愈,治愈率57.14%,两组间治愈率差异具有统计学意义(χ~2=6.887,P=0.031,P0.05)。23例侧方扩散波消失组中,7例为眼轮匝肌消失,6例治愈,1例未愈,治愈率85.71%;16例为眼轮匝肌和颏肌均消失,16例均治愈,治愈率100%;未发现颏肌消失。眼轮匝肌LSR消失组与同时消失组两组间治愈率差异无统计学意义(χ~2=2.390,P=0.304,P0.05)。结论面肌痉挛微血管减压术中使用侧方扩散波监测有利于提高手术疗效。     

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

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。     

面肌痉挛微血管减压术后持续性异常肌反应对预后的影响

目的 探讨异常肌反应（AMR）在面肌痉挛（HFS）微血管减压术（MVD）后持续存在的意义。方法 回顾性分析2012年2月至2017年2月MVD治疗的168例HFS的临床资料。术中进行电生理监测记录AMR波,其中162例监测到AMR波,术后130例AMR波形消失（AMR波消失组）,32例波形未消失（AMR波未消失组）。结果 AMR波消失组术后即刻治愈率（90.8%,118/130）明显高于AMR波未消失组（46.9%,15/32;P<0.05）。两组术后并发症发生率无统计学差异（3.8% vs. 3.8%;P>0.05）。AMR波消失组128例获得随访,随访时间13~71个月,平均41.2个月;AMR波未消失32均获得随访,随访时间15~70个月,平均43.6个月。AMR波消失组随访治愈率（94.5%）与AMR波未消失组（93.8%）无统计学差异（P>0.05）。结论 HFS病人MVD中,AMR监测对判断面神经减压是否充分具有一定的指导价值;术后AMR波形持续存在并不意味着预后不佳。     

全程减压与常规微血管减压治疗面肌痉挛的对比研究

目的 探讨面神经异常肌反应监测下全程减压与常规微血管减压治疗面肌痉挛的显微手术技术和手术疗效.方法 回顾性分析2003年7月至2010年3月采用两种方法治疗的1 860例面肌痉挛患者的临床资料.按手术方式不同分为A、B两组,A组650例,采用常规面神经出脑干区(REZ)微血管减压术治疗;B组1 210例,在面神经异常肌反应监测下行全程减压术.结果 A组:手术疗效:术后症状缓解共582例(89.53%),无效68例(10.46%);术后并发症:面瘫24例(3.69%),耳鸣、听力下降31例(4.76%),吞咽困难、呛咳3例.B组,手术疗效:术后症状缓解共1 185例(98%),无效25例(2.07%);术后并发症:面瘫46例(3.80%),耳鸣、听力下降76例(6.28%),吞咽困难、呛咳3例.B组与A组相比,治愈率有显著性差异(P<0.01),并发症发生率无显著差异(P>0.05).结论 面肌异常肌反应监测下对面神经根全程充分减压,在未增加并发症的情况下能有效提高治愈率.     

面肌痉挛显微血管减压术中异常肌反应监测价值研究

目的探讨异常肌反应(AMR)监测在鉴别责任血管、评估减压效果以及判断预后方面的作用。方法24例面肌痉挛患者接受了术中AMR监测的研究,麻醉诱导后不使用肌松剂。采取刺激面神经颧支,记录同侧颏肌电反应的方法,分析AMR监测结果与术后疗效的关系。结果术中所有患者均记录到特征性的AMR波形。面神经根减压后AMR消失20例,AMR未消失4例。AMR消失的20例患者术后1周17例患者面肌痉挛消失,随访结果20例患者面肌痉挛消失。术中AMR未消失的4例患者术后1周1例患者面肌痉挛消失,随访结果2例患者面肌痉挛消失。经统计学分析AMR消失组的疗效明显好于AMR未消失组。结论术中AMR监测有助于鉴别责任血管,评估即刻减压效果,有助于判断手术的预后,能够显著提高面肌痉挛患者手术的长期效果。     

Role of arterioles in management of microvascular decompression in patients with hemifacial spasm

Although microvascular decompression (MVD) is accepted as an effective therapy for hemifacial spasm (HFS), some operations fail. While performing MVD, many surgeons focus on the large arteries but ignore the arterioles. Failure to identify involved arterioles may account for unsuccessful MVD. We aimed to refine the MVD surgery and improve post-operative outcomes by proper management of involved arterioles. Clinical data were collected from 69 consecutive patients who underwent MVD. Intraoperative electromyography (EMG) was employed for each MVD. Each operation was reviewed with a focus on the involved arterioles. All patients were followed up for between nine and 12 months. An abnormal muscle response (AMR) wave was identified by EMG in all patients before decompression, but vanished in most patients as soon as the involved arteries were removed from the cranial nerve (CN). However, in nine of 69 patients, the AMR did not immediately disappear. Further dissection and exploration of the entire CN VII identified an arteriole in contact with, or in some patients embedded in, the nerve. Once the arteriole was isolated from the CN, the AMR disappeared. After surgery, spasms ceased in all patients and no recurrence was found up to the one-year follow-up. To achieve a positive post-operative outcome, exploration of the entire CN VII is necessary, with a focus on the small arterioles. AMR can be a good adjuvant to identify the involved arterioles.     

Prognostic value of intra-operative abnormal muscle response monitoring during microvascular decompression for long-term outcome of hemifacial spasm

The reliability of intra-operative abnormal muscle response (AMR) monitoring as an indicator of post-operative outcome in patients with hemifacial spasm (HFS) is under debate. The primary aim of this study was to evaluate the correlation between intra-operative AMR changes and long-term post-operative outcome. We monitored intra-operative AMR during microvascular decompression (MVD) in consecutive patients with HFS (n = 104). Patients in this study were divided into two groups based on whether their AMR disappeared or persisted following MVD. Ninety patients were followed-up, and the mean duration from surgery to final follow-up examination was 3.7 years. Fourteen patients were lost to follow-up. AMR disappeared during surgery for 80 patients; of these, 74 achieved complete resolution of HFS, five had persistent HFS, and one patient developed a recurrence of HFS. Of the 10 patients with persistent AMR despite effective MVD, eight patients achieved complete resolution, one patient had persistent HFS, and one developed recurrent HFS. The long-term clinical outcome of HFS after MVD did not significantly correlate with intra-operative AMR changes (p = 0.791). Therefore, we suggest that intra-operative AMR monitoring may not be a reliable indicator of long-term post-operative outcome for HFS.     

显微血管减压术治疗原发性面肌痉挛合并原发性三叉神经痛的疗效分析

目的 探讨显微血管减压术（MVD）治疗原发性面肌痉挛（pHFS）合并原发性三叉神经痛（PTN）的疗效。方法 回顾性分析2015~2017年MVD治疗的11例pHFS合并PTN的临床资料。结果 术中发现10例与椎动脉压迫密切相关。11例术后随访2~4年;面部抽搐术后即刻治愈9例,延迟治愈2例;面部疼痛术后即刻治愈10例,明显缓解1例。术后发生后组颅神经损伤1例、听力下降1例,无面瘫、脑脊液漏、颅内出血等并发症。结论 pHFS合并PTN病人责任血管常较复杂,与椎动脉压迫密切相关,MVD治疗安全、有效。