侧方扩散反应电位监测在面神经显微血管减压术的意义

目的探讨面肌痉挛微血管减压(MVD)术中监测侧方扩散反应(LSR)的临床意义。方法回顾性分析35例面肌痉挛病人的临床资料,均行乙状窦后入路面神经MVD,术中电生理监测LSR。结果 35例病人术中均监测到LSR,LSR术中消失33例,术后病人症状完全消失者;2例术中LSR未消失,其中症状部分缓解1例,未缓解1例。结论 MVD术中监测LSR能够帮助术者判断责任血管,减少神经、血管牵拉时间,提高面肌痉挛MVD疗效。     

侧方扩散反应监测在面肌痉挛微血管减压术中的应用

目的 探讨侧方扩散反应（LSR）监测在面肌痉挛（HFS）微血管减压术（MVD）中的应用价值。方法 回顾性分析2016年6月至2018年8月MVD治疗的70例HFS的临床资料,术中均监测LSR。术后1周、1年根据Cohen分级评估术后疗效,0级为治愈。结果 70例均监测到LSR,其中LSR消失65例（消失组）,确认充分减压后LSR仍持续存在5例（未消失组）。术后1周,消失组治愈率[92.3%（60/65）]明显高于未消失组[40.0%（2/5）;P<0.05]。术后1年,消失组治愈[96.9%（63/65）与未消失组[80.0%（4/5）]无统计学差异（P>0.05）。结论 MVD治疗HFS,术中监测LSR可以帮助确定责任血管,尽可能减少责任血管的遗漏;术中LSR消失提示近期疗效较好,但对长期疗效的预测价值有限。     

神经电生理监测及多模态影像融合技术在面肌痉挛微血管减压术中的应用

目的 探讨神经电生理监测及多模态影像融合技术在面肌痉挛（HFS）微血管减压术（MVD）中的应用效果。方法 回顾性分析2019年6月至2020年6月神经电生理监测及多模态影像融合技术辅助MVD治疗的6例HFS的临床资料。术前应用3D Slicer软件进行多模态影像融合分析责任血管并制定手术方案,术中全程监测侧方扩散反应（LSR）。结果 6例多模态影像融合显示责任血管与术中所见完全相符。6例术中充分减压后LSR波形消失,术后Cohen评分0分4例,1分1例,2分1例;术后随访6个月,颜面部抽搐症状均消失,术后12个月未见症状复发。结论 神经电生理监测联合多模态影像融合可帮助制定手术方案,提高手术疗效。     

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。     

面肌痉挛显微血管减压术的诱发肌电图监测和评估

目的:探讨面神经诱发肌电图在显微血管减压(MVD)术中、术后对面肌痉挛治疗效果的监测和评估。方法:对26例典型面肌痉挛病人、探讨在MVD术前、术中、术后,经皮刺激痉挛侧(手术侧)面神经下颌缘支,记录诱发同侧眼轮匝肌肌电位(MD-OC反应)变化,并以正常侧作对照检查。结果:26例术前均记录到痉挛侧MD-OC反应,在术中操作不同阶段,21例均见MD-OC反应消失。术后1周～3个月随访复查21例中,12例痉挛完全消失,MD-OC反应不复存在,9例症状明显或部分减轻,但有4例再记录到MD-OC反应。另5例术中,术后均记录到MD-OC反应,症状未有改善。结论:面神经诱发肌电图运用于MVD术中监测和预后判断,可改善和提高面肌痉挛的治愈率。     

侧方扩散反应监测在面肌痉挛微血管减压术中的作用

目的分析侧方扩散反应监测在面肌痉挛微血管减压术中的作用。方法结合遵义医学院附属医院2016年1月～2017年8月采用侧方扩散反应(Later spread response,LSR)监测下行显微血管减压术治疗的38例原发性面肌痉挛患者资料,术前均行面神经诱发电位、3D-TOF-MRA、3D-FIESTA序列检查明确诊断、同时排除颅内占位等继发性因素,LSR监测下由同一术者行显微血管减压术,结合术中LSR波形变化情况明确责任血管、有效评估减压效果。术后随访6个月,观察并评估术后恢复情况。结果 37例手术开始前记录到LSR波形,其中Teflon棉垫离面神经的压迫血管后消失26例; 4例垫入Teflon棉后LSR波形复现,重新探查、调整棉片位置后波形消失; 3例剪开硬脑膜、释放脑脊液后消失; 1例患者探及小脑前下动脉与面神经贴近伴行后即予适量Teflon棉垫离,LSR波幅下降小于50%,关闭硬脑膜前再次探查面神经全程发现遗漏责任血管并予有效隔离,LSR波消失。3例至手术结束时,LSR波幅下降均大于75%,但未完全消失。术后随访6个月,治愈32例(86. 49%),明显缓解4例(10. 81%),部分缓解1例(2. 70%)。1例患者术前曾外院使用肉毒素注射治疗,未引出LSR。结论面肌痉挛微血管减压术中结合LSR监测波形变化反馈责任血管对面神经的激惹情况,对于术中精准识别责任血管、避免责任血管遗漏及客观评估减压效果具有重要指导意义。     

3D Slicer三维重建技术联合LSR监测在面肌痉挛微血管减压术中的应用

目的 探讨3D Slicer三维重建技术联合侧向扩散反应（LSR）监测在面肌痉挛（HFS）微血管减压术（MVD）中的应用效果。方法 回顾性分析2015年4月至2021年6月3D Slicer三维重建技术联合LSR监测下行MVD治疗的40例HFS的临床资料。术前行3D-FIESTA和3D-TOF MRA检查,根据3D-Slier软件三维重建结果进行术前评估,术中行LSR监测。结果 3D-FIESTA和3D-TOF MRA检查判断神经血管关系、识别责任血管与术中所见的一致性一般（K值分别为0.389、0.492;P<0.05）,3D Slier三维重建技术判断神经血管关系、识别责任血管与术中所见的一致性较好（K值分别为0.691、0.778;P<0.001）。术中LSR消失33例,LSR未消失7例。术后随访1年,术中LSR消失病人有效率（96.7%,32/33）较LSR未消失病人（57.1%,4/7）明显增高（P<0.05）。结论 对HFS病人,3D Slier三维重建技术有助于提高术前判断神经血管关系、识别责任血管的准确率,术中LSR监测有助于评估病人的预后。     

神经电生理监测在微血管减压术中的应用研究

目的探讨神经电生理监测在微血管减压术(MVD)中的应用价值和临床意义。方法回顾性分析121例神经电生理监测辅助下行MVD术的病例资料,其中原发性三叉神经痛50例,面肌痉挛64例,舌咽神经痛7例;均行显微镜下经枕下-乙状窦后入路MVD术,术中行脑干听觉诱发电位(BAEP)、异常肌反应(AMR)和肌电图(EMG)监测。结果三叉神经痛治愈46例,明显缓解3例,部分缓解1例;面肌痉挛治愈57例,明显缓解5例,部分缓解1例,无效1例;舌咽神经痛疗效佳6例,疗效一般1例。术后并发症主要有:面瘫1例,面部麻木8例,听力下降6例,耳鸣7例,吞咽障碍1例,声音嘶哑1例,颅内感染3例;随访6~12个月,多数并发症缓解,无复发和死亡病例。结论神经电生理监测辅助下行MVD术可提高手术疗效,有效保护脑神经功能,减少发生并发症,改善病人预后。     

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。     

显微血管减压术治疗面肌痉挛的临床研究

目的分析显微血管减压术(MVD)治疗面肌痉挛的操作要点和评价其疗效,并探讨术中监测异常肌反应的应用价值。方法回顾性分析采用MVD治疗的186例面肌痉挛病例资料。责任血管为小脑前下动脉98例,小脑后下动脉58例,椎动脉9例,小脑前下动脉和小脑后下动脉共同压迫21例。结果出院时,面肌痉挛症状完全消失142例(76.3%),痉挛症状改善33例(17.7%),痉挛症状较术前无明显变化11例(6%)。围手术期脑脊液耳漏1例,术后耳鸣3例,均治愈,无死亡病例。随访6个月~2年,面肌痉挛症状完全消失169例(90.9%),症状较术前改善14例(7.5%),症状无改善3例(1.6%)。结论 MVD治疗面肌痉挛安全、有效,术中监测异常肌反应信号有助于判断减压效果,评判手术疗效应考虑延迟治愈的可能。     

Predictive value of intraoperative blink reflex monitoring for surgical outcome during microvascular decompression for hemifacial spasm

ObjectiveTo investigate the prognostic and predictive value of intraoperative blink reflex (BR) monitoring during microvascular decompression (MVD) for hemifacial spasm (HFS).MethodsWe retrospectively reviewed 41 patients with HFS undergoing MVD with intraoperative BR and lateral spread response (LSR) monitoring. Facial spasm was evaluated for six months postoperatively.ResultsThe BR resolved in 38 patients and persisted in three after MVD. For patients who exhibited BR resolution, 1-day, 1-month, and 6-month follow-ups revealed that 35 (92.1%), 35 (92.1%), and 38 (100%) patients had spasm resolution, respectively. However, of the three patients with persistent BR, one (33.3%), one (33.3%), and zero (0%) patients exhibited spasm resolution at the three corresponding follow-ups. We found a statistically significant difference in spasm resolution between the persistent and resolved BR groups at six months postoperatively. A comparison between intraoperative BR and LSR monitoring revealed that BR was a better predictor of clinical outcomes.ConclusionsIntraoperative BR monitoring is a potentially useful tool to help facilitate an adequate decompression and is a reliable prognostic predictor of surgical outcome.SignificanceThis study is the first to document the relationship between intraoperative BR monitoring and surgical outcome in patients with HFS.     

面肌痉挛微血管减压术中电生理监测对手术疗效的影响

目的评价微血管减压术中根据电生理监测结果进行操作对面肌痉挛手术疗效的影响。方法采用监测面神经侧方扩散反应(LSR)的方法,对120例面肌痉挛患者(A组)进行术中监测,根据监测结果对面神经从面神经根至入内听道全长实施有效的减压,并将结果与120例未监测组(B组)进行近期疗效和远期疗效的对比。结果术后近期治愈率:A组76.7%,B组63.3%。随访治愈率:A组90.0%,B组88.3%。总有效率:A组97.5%,B组95.0%。结论根据监测结果对面神经进行充分减压能够降低术后延迟治愈的发生率。面神经远侧端责任血管压迫对面肌痉挛手术的疗效有明确影响。     

Efficacy of the Disappearance of Lateral Spread Response before and after Microvascular Decompression for Predicting the Long-Term Results of Hemifacial Spasm Over Two Years

Objective

The purpose of this large prospective study is to assess the association between the disappearance of the lateral spread response (LSR) before and after microvascular decompression (MVD) and clinical long term results over two years following hemifacial spasm (HFS) treatment.

Methods

Continuous intra-operative monitoring during MVD was performed in 244 consecutive patients with HFS. Patients with persistent LSR after decompression (n=22, 9.0%), without LSR from the start of the surgery (n=4, 1.7%), and with re-operation (n=15, 6.1%) and follow-up loss (n=4, 1.7%) were excluded. For the statistical analysis, patients were categorized into two groups according to the disappearance of their LSR before or after MVD.

Results

Intra-operatively, the LSR was checked during facial electromyogram monitoring in 199 (81.5%) of the 244 patients. The mean follow-up duration was 40.9±6.9 months (range 25-51 months) in all the patients. Among them, the LSR disappeared after the decompression (Group A) in 128 (64.3%) patients; but in the remaining 71 (35.6%) patients, the LSR disappeared before the decompression (Group B). In the post-operative follow-up visits over more than one year, there were significant differences between the clinical outcomes of the two groups (p<0.05).

Conclusion

It was observed that the long-term clinical outcomes of the intra-operative LSR disappearance before and after MVD were correlated. Thus, this factor may be considered a prognostic factor of HFS after MVD.     

Effect of botulinum neurotoxin treatment in the lateral spread monitoring of microvascular decompression for hemifacial spasm

Introduction: Botulinum neurotoxin (BtNtx) treatment for hemifacial spasm (HFS) prior to microvascular decompression (MVD) is hypothesized to be a factor in the variability of intraoperative neurophysiological monitoring (IONM) during this procedure. Methods: We analyzed 282 MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000 and December 31, 2007. We retrospectively compared the lateral spread response (LSR) in the mentalis muscle when stimulus‐triggered electromyography (EMG) was elicited from the facial nerve. Previous BtNtx treatment was the grouping factor. Results: Baseline LSR amplitudes during MVD (prior BtNtx: mean = 341.47 μV; no BtNtx: mean = 241.81 μV) were significantly different between groups (df = 1,281; t = ?2.463; P = 0.014). Comparisons of latency and current threshold at baseline, as well as HFS disappearance or LSR persistence after the procedure, did not achieve statistical significance. Conclusions: HFS patients treated with BtNtx prior to MVD demonstrated higher LSR baseline amplitudes during IONM. This could be related to muscle poly‐reinnervation after recovery from repeated BtNtx use. Muscle Nerve, 2011     

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.     

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.     

显微血管减压术治疗面肌痉挛的症状转归

目的观察面肌痉挛显微血管减压术后的症状变化规律。方法 2006年11月~2007年7月104例面肌痉挛患者接受了异常肌反应电生理监测下的显微血管减压术,随访术后疗效,分析术后症状的演变规律。结果术后随访3.2~4年,14例失访。在资料完整的90例患者中,随访期内82例治愈,2例症状明显改善,4例无效,2例复发。在治愈的82例患者中:57例术后即刻治愈;25例出现延迟治愈,症状消失时间为术后3天~1.5年。有78例(95.1%)在术后半年内症状消失。结论显微血管减压术后,面肌痉挛症状整体呈进行性改善的趋势,症状消失时间主要集中在术后半年内。