面肌痉挛显微血管减压术中脑干听觉诱发电位监测的应用

目的 研究脑干听觉诱发电位(BAEP)监测在显微血管减压术(MVD)治疗面肌痉挛手术中的应用.方法 回顾性分析90例面肌痉挛患者在MVD术中进行BAEP监测的临床资料.结果 MVD手术操作过程均可引起BAEP改变,包括:BAEP的Ⅰ、Ⅲ、Ⅴ波绝对潜伏期明显延长(P＜0.01),Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波间期明显延长(P＜0.01),Ⅲ波、Ⅴ波波幅明显降低(P＜0.01);有16例术中Ⅴ波绝对潜伏期延长超过1ms,Ⅰ波波幅也有明显降低(P＜0.01),但术后无听力障碍;手术结束时Ⅲ～Ⅴ波间期及16例的Ⅰ、Ⅴ波波幅恢复较快.2例术后患侧听力丧失的患者中,1例术中Ⅴ波波幅逐渐降低至消失,另1例术中未监测到Ⅴ波波形.结论 MVD手术操作过程均可引起BAEP改变;Ⅴ波绝对潜伏期延迟超过1ms者相对多见,但无听力受损;Ⅴ波波幅下降程度可为术中神经功能受损提供客观指标,以采取相应措施减少听力并发症的发生.     

后颅窝肿瘤患者脑干听觉诱发电位初步研究：20例MRI和CT对照分析

以 MRI 和 CT 为对照分析了20例脑干和小脑肿瘤患者脑干听觉诱发电位(BAEP)的检查结果,发现 BAEP 异常者19例,BAEP 正常者1例。BAEP 异常主要表现为:Ⅰ～Ⅶ各波消失,Ⅴ波波幅降低,波幅比Ⅴ/Ⅰ<1,波间期Ⅰ～Ⅲ、Ⅲ～Ⅴ和Ⅰ～Ⅴ延长,波间期比Ⅲ～Ⅴ/Ⅰ～Ⅲ>1,与 MRI 和 CT 结果对照分析表明除肿瘤本身以外,脑干受压移位、脑脊液通路受阻也是BAEP 异常、特别是病灶对侧异常的重要原因。     

脑干听觉诱发电位监护在脑干肿瘤手术中的应用研究

目的研究脑干及相应颅神经功能损伤时较敏感的电生理指标,为脑干肿瘤手术提供精确、准确和安全的术中监测手段。方法对18例脑干肿瘤病人,用同一进口监护仪于手术前、术中及术后分别进行脑干听觉诱发电位(BAEP)连续实时监护,测定手术操作对这些指标的影响。结果脑干肿瘤手术操作均可以引起BAEP改变,BAEP的Ⅰ、Ⅲ、Ⅴ波潜伏期(PL)及Ⅰ～Ⅴ、Ⅲ～Ⅴ峰间潜伏期(IPL)明显延长(P<0.01),Ⅴ波波幅明显降低(P<0.01),其中BAEP的Ⅴ波潜伏期及波幅改变最为显著。结论BAEP的Ⅴ波潜伏期延长和波幅下降是术中敏感的电生理指标,对其进行监护可为手术中及手术后避免神经功能损伤提供客观指标,降低手术伤残率,减少或避免病人手术后神经功能损伤。     

后循环梗死患者的BAEP、BR、TCR变化的临床意义

目的探讨后循环梗死（PCI）患者脑干听觉诱发电位（BAEP）、瞬目反射（BR）、三叉神经-颈反射（TCR）三种电生理变化。方法选择50例经头颅MRI检查证实为PCI患者,分别行BAEP、BR、TCR检查。BAEP观察其波形,Ⅰ、Ⅲ、Ⅴ峰波潜伏期（PL）、峰波间期（IPL）、波幅（Amp）;BR观察R1、R2、R2’波平均潜伏期、波幅;TCR观察各成分潜伏期、波幅、A值。结果 50例中,BAEP检查异常45例,异常率90%,异常主要表现为Ⅲ、Ⅴ波PL延长,Ⅲ～ⅤIPL大于Ⅰ～ⅢIPL,Ⅰ/Ⅴ波幅大于1。BR检查异常42例,异常率84%,异常主要表现为R1、R2、R2’波PL延长,R2、R2’波幅下降。TCR检查仅5例异常,异常率10%,头颅MRI显示多为延髓梗死。结论 BAEP、BR两种电生理检查方法能较好反映PCI患者脑干功能异常;TCR电生理检查方法异常率低,但对延髓梗死检查有特异性。三者联合应用可提供重要参考价值。     

59例听神经瘤患者脑干听觉诱发电位分析

目的 分析听神经瘤(acoustic neuroma,AN)患者的脑干听觉诱发电位的变化特征及健侧耳峰间期改变.方法 对59例听神经瘤(AN)患者进行脑干听觉诱发电位(BAEP)检测,测定Ⅰ、Ⅲ、Ⅴ波潜伏期(PL)、峰间期(IPL),双耳PL、IPL之间差值(ILD)等数值.结合MRI、CT影象学资料进行分析,并与36例健康者对照.结果 AN组与正常对照组BAEP各波PL、IPL测值比较差异有极显著性(P＜0.01).AN患侧BAEP异常率98.3%(58/59);主要表现:①Ⅰ、Ⅲ、Ⅴ波缺失;②Ⅲ、Ⅴ波PL延长;③Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长.AN患者健侧BAEP的异常率69.5%(41/59),主要表现:①Ⅴ波PL延长;②Ⅲ～Ⅴ及Ⅰ～Ⅴ波IPL延长;③Ⅲ～Ⅴ/Ⅰ～Ⅲ波IPL比值＞1.肿瘤直径＞2cm,BAEP的异常率有显著提高.不同大小肿瘤组间健侧BAEP测值比较:健侧Ⅴ波PL差异有显著性(P＜0.05),Ⅲ～Ⅴ及Ⅰ～ⅤIPL差异有极显著性(P＜0.01).结论 BAEP对AN诊断具有重要意义,它为病变提供了定位诊断依据,尤其健侧Ⅲ～Ⅴ/Ⅰ～Ⅲ波IPL比值异常,是脑干受压的敏感指标.     

创伤后应激障碍患者的脑干诱发电位分析

目的：探讨创伤后应激障碍（PTSD）患者的脑干听觉诱发电位（BAEP）变异特点及其与心身症状的关系。方法：对54例PTSD患者进行BAEP检测和心身症状评定,分析BAEP与心身症状的相关性,并与健康人作比较。结果：PTSD患者Pz脑区Ⅲ、Ⅴ波绝对潜伏期和Ⅰ～Ⅲ波间期均延迟,Ⅲ～Ⅴ波间期缩短,Ⅴ／Ⅰ波波幅比下降;症状自评量表（SCL-90）的总分及其躯体化、强迫、抑郁、焦虑因子分,事件影响量表（IES）的总分及其回避、闯入因子分显著高于对照组;Pz脑区BAEP各波的观察指标与大部分心身症状的相关有显著性意义。结论：BAEP检测为PTSD患者的临床辅助诊断提供了一种敏感、客观的电生理学手段。     

孤独症谱系障碍患儿婴儿期体格、神经心理发育及脑干听觉诱发电位特征

目的:探讨孤独症谱系障碍(ASD)患儿婴儿期体格、神经心理发育及脑干听觉诱发电位(BAEP)特征。方法:收集21例2～6岁ASD患儿(ASD组)在其1、3、6及12月龄时体格发育资料(体质量、身长和头围)、神经心理发育评估资料[包括智力发展指数(MDI)和精神运动发展指数(PDI)]及BAEP检测结果(包括Ⅰ、Ⅲ、Ⅴ波潜伏期及I-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ峰间期),并与63名同龄正常儿童(对照组)比较。结果:两组婴儿期各月龄体格发育水平比较差异无统计学意义(P>0.05)。神经心理发育评估显示,12月龄时ASD组MDI和PDI明显低于对照组(P均<0.01)。BAEP检测结果显示,1及3月龄时ASD组BAEPⅠ波、Ⅲ波、Ⅴ波潜伏期、Ⅰ-Ⅲ峰间期、Ⅲ-Ⅴ峰间期及Ⅰ-Ⅴ峰间期明显长于对照组(P<0.05或P<0.01)。ASD组异常频率最多的是V波潜伏期延长(47.2%)。结论:婴儿期早期(1～3月龄)持续V波潜伏期延长、12月龄时神经心理发育迟缓可能为ASD患儿早期特征性改变,可作为ASD早期预警指标之一。     

听神经瘤术中神经电生理监护的应用分析

目的研究听神经瘤术中脑干及相应颅神经功能较敏感的电生理监测手段,以达到减少伤残率及提高颅神经的解剖及功能保留率。方法对28例听神经瘤病人,用同一监护仪于手术前、术中及术后分别进行脑干听觉诱发电位(BAEP)及肌电图连续实时监护,观察手术操作对它们的影响。结果听神经瘤手术操作均可以引起BAEP改变,BAEP的Ⅰ、Ⅲ、Ⅴ波潜伏期,Ⅰ-Ⅴ、Ⅲ-Ⅴ峰间潜伏期的明显延长(P<0.05),Ⅴ波波幅明显降低(P<0.05),其中BAEP的Ⅴ波潜伏期及波幅改变最为显著。当接近、触及、牵拉、刺激面神经时,肌电图出现突发的、双相或多相的高幅电位改变,而通过直接电刺激可定位面神经解剖,面神经的解剖及功能保留得以明显提高。结论BAEP的Ⅴ波潜伏期延长和波幅下降以及突发的双相或多相的高幅肌电图改变是听神经瘤术中敏感的电生理指标,对其进行监护,可为术中避免神经功能损伤及术后其功能预测提供客观指标,降低手术伤残率。     

不同意识状态下中风患者脑干诱发电位特点

为探讨中风患者在不同意识状态下BAEP特点，分别对27例有意识障碍及25例无意识改变的非脑干部位性中风患者进行BAEP的测定。结果：意识障碍组的Ⅲ、Ⅴ波潜伏期及Ⅴ－Ⅲ、Ⅲ－I波间期延长，同正常对照组及无意识障碍中风组间均有非常显著的差异（P＜0．001），2例Ⅲ、Ⅴ波均消失的昏迷患者死亡。无意识改变的中风患者组Ⅲ、Ⅴ波潜伏期及Ⅴ－Ⅲ、Ⅲ—Ｉ波间期同正常对照组间无显著差异（P＞0．05）。表明非脑干部位性中风患者出现意识障碍，脑干功能继发性受损，同时显示BAEP能对有意识障碍的中风患者的预后做出有价值的判断。     

痉挛性斜颈脑干听觉诱发电位临床分析

目的探讨痉挛性斜颈患者脑干听觉诱发电位的功能变化。方法比较分析30例痉挛性斜颈患者及30例正常对照患者(颈部向右侧扭转)脑干听觉诱发电位双侧Ⅰ/Ⅴ波高比及Ⅰ～Ⅲ、Ⅲ～Ⅴ波间期的差异。结果病例组脑干听觉诱发电位双侧的Ⅰ～Ⅲ、Ⅲ～Ⅴ波间期正常,斜颈同侧的Ⅰ～Ⅲ波间期较对侧延长,差异有统计学意义(P<0.05);双侧Ⅲ～Ⅴ波间期及Ⅰ/Ⅴ波高比比较差异无统计学意义(P>0.05)。正常对照组颈部向右侧扭转时双侧比较Ⅰ～Ⅲ波间期、Ⅲ～Ⅴ波间期、Ⅰ/Ⅴ波高比比较差异无统计学意义(P>0.05)。结论脑干听觉诱发电位双侧Ⅰ～Ⅲ、Ⅲ～Ⅴ波间期正常提示脑干上部传导通路结构正常,斜颈扭转方向的同侧Ⅰ～Ⅲ波间期较对侧延长提示同侧的传导通路功能异常。     

脑干听觉诱发电位分级对脑创伤长期意识障碍患者清醒预测的价值

目的 探讨脑干听觉诱发电位(BAEP)分级标准对脑创伤后长期意识障碍患者清醒预测的价值.方法 分析93例脑创伤后长期意识障碍患者的BAEP表现,将BAEP分为3级:Ⅰ级为各波均正常;Ⅲ级为双侧V波PL异常、双侧Ⅲ～Ⅴ波IPL异常、单侧或双侧V波消失;Ⅱ级为除Ⅲ级之外的任何异常BAEP表现.以脑创伤后6个月作为判断是否清醒的时间标准.结果 Ⅰ级、Ⅱ级、Ⅲ级的清醒率分别为:79％、18％和0％.分级与清醒差异有统计学意义(r=-0.662,P＜0.001),分级越高,清醒越困难.BAEP分级标准对清醒预测的ROC曲线下面积为0.859,95％可信区间为(0.781～0.937).结论 BAEP分级能客观、准确地反映脑功能损伤程度和预测清醒的概率.     

脑创伤后长期意识障碍患者脑干听觉诱发电位表现与预后清醒的关系

目的 探讨重型创伤性颅脑损伤(TBI)后长期意识障碍患者脑干听觉诱发电位(BAEP)表现与预后清醒的关系.方法 分析63例重型TBI后意识障碍超过2周患者的BAEP表现,主要为BAEP中Ⅰ、Ⅲ、Ⅴ波各波峰潜伏期(PL),Ⅰ～Ⅲ、Ⅲ～Ⅴ波峰间潜伏期(IPL)及Ⅰ波与Ⅴ波波幅比.预后以TBI后6个月患者是否清醒为标准,分为清醒组与未清醒组,组间运用两独立样本t检验以筛选出有意义的指标.结果 本组患者清醒率为34.9%(22/63),BAEP指标异常率为66.7%(42/63).双侧Ⅰ、Ⅲ、Ⅴ波PL,Ⅰ～Ⅲ波、Ⅲ～Ⅴ波IPL及Ⅰ/Ⅴ波幅比均正常的21例中有16例清醒(清醒率为76.2%),双侧Ⅴ波PL异常的8例及双侧Ⅲ～Ⅴ波IPL异常的7例均未清醒,单侧Ⅴ波消失的2例未清醒.清醒组与未清醒组间比较发现双侧差异均有统计学意义的指标为Ⅴ波PL及Ⅲ～Ⅴ波IPL.结论 BAEP的Ⅴ波PL及Ⅲ～Ⅴ波IPL变化可客观、准确地反映脑损伤的程度及预测患者的预后.

Abstract：

Objective To explore the correlation between brainstem auditory evoked potential (BAEP) findings and outcome in long-term unconscious patients with severe traumatic brain injury (TBI).Methods BAEP findings were recorded and analyzed in 63 patients suffering from severe TBI with duration of disturbance of unconsciousness for more than 2 weeks. The peak latency (PL) of wave Ⅰ, Ⅲ and Ⅴ, the interpeak latency (IPL) of wave Ⅰ-Ⅲ and Ⅲ-Ⅴ and the amplitude ratio of wave Ⅰ and Ⅴ were analyzed. Conscious or unconscious at 6 months after the injury was considered as the outcome criterion,and based on these, the patients were divided into conscious and unconscious groups; the significant indicators were chosen in the 2 groups using independent-sample t test. Results The probabilities of awakening in these patients were 34.9% (22/63) with abnormal index of BAEP indicators reaching 66.7%. Sixteen patients were sober at last in 21 patients with normal PL of wave Ⅰ, Ⅲ and Ⅴ, IPL of wave Ⅰ-Ⅲ and Ⅲ-Ⅴ, and amplitude ratio of wave Ⅰ and Ⅴ in bilateral side (the probabilities of awakening were 76.2%); 8 patients having abnormal PL of wave Ⅴ in bilateral side and 7 having abnormal IPL of wave Ⅲ-Ⅴ in bilateral side were unconscious; 2 patients having disappeared wave Ⅴ in unilateral side were unconscious. PL of wave Ⅴ and IPL of wave Ⅲ-Ⅴ in bilateral side were significantly different between the conscious group and the unconscious group. (P＜0.05). Conclusion BAEP findings (PL of wave Ⅴ and IPL of wave Ⅲ-Ⅴ in bilateral side) can objectively and accurately demonstrate the cerebral dysfunction and predict the outcome of the patients.     

大鼠脑桥、中脑电损伤后脑干听觉诱发电位的敏感性研究

目的 探讨大鼠脑桥、中脑电损伤后脑干听觉诱发电位(BAEP)的敏感指标.方法 SD大鼠80只,分别于左侧脑桥面丘和中脑上下丘之间深部给予电损伤,按照电流刺激量的不同各分为小剂量组(1 mA)、中剂量组(3 mA)、高剂量组(6 mA)、对照组(0 mA),每组10只,记录和比较各组电损伤前后的BAEP各指标的变化.每组取2只行病理学检查.结果 电损伤后,脑组织均有不同程度的神经元坏死等改变,损伤程度随电流量加大而增加.脑桥小剂量组BAEP的V波的PL、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长,中剂量组的Ⅲ、V波的PL、Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长,高剂量组的Ⅲ、Ⅴ波的PL、Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL延长,伴Ⅲ、Ⅴ波的波幅下降;中脑中剂量组、高剂量组V波PL延长,Ⅰ～Ⅴ、Ⅲ～Ⅴ波IPL延长,损伤前后的差值与对照组比较,有统计学意义.结论 (1)BAEP的Ⅴ波PL可能为反映脑桥和中脑损伤的敏感指标;(2)BAEP反映中脑损伤不如脑桥敏感.

Abstract：

Objective To explore the sensitive indexes of brainstem auditory evoked potentials(BAEP)in rats exposed to electric injury in the pons and the midbrains.Methods The pones and midbrains of 80 rats were electric injured beneath the left facial colliculus and quadrigeminal bodies.In the pone group or the midbrain group,the animals were further divided into 4 groups:controls(0 mA),low (1 mA),middle(3 mA)and high electric current(6 mA)respectively,according to the amount of electrical stimulation.The indexes of BAEP were recorded and analyzed before and after injury.Results It was shown that electric injury resulted in neuronal necrosis,the extent of which tended to be designated as much more severe according to the amount of electrical stimulation.In the pone groups,the peak lantency(PL)of waves Ⅴ and the interpeak lantency(IPL)of waves Ⅰ～Ⅴ,Ⅲ～Ⅴ were prolonged at low electric current. However,the PL of waves Ⅲ,Ⅴ and the IPL of waves Ⅰ～Ⅲ,Ⅲ～Ⅴ,Ⅰ～Ⅴ were prolonged at middle and high electric current,and the amplitudes of waves V were decreased at high electric current significantly compared with the controls.In the midbrain groups,the PL of waves Vand the IPL of waves Ⅲ～Ⅴ,Ⅰ～Ⅴ at middle and high electric current were prolonged significantly compared with the controls.Conclusions The peak lantency of the waves V may be the most sensitive indexes of BAEP as to the pons and midbrains injured,but the changes of BAEP is less sensitive in midbrain than in pons.     

Characteristics of brainstem auditory evoked potential of neonates with mild or moderate hyperbilirubinemia

BACKGROUND: Brainstem auditory evoked potential (BAEP) has been widely used to evaluate the functional integrity and development of injured auditory system and brain, especially to objectively evaluate the function of auditory system and brain stem of very young babies, such as neonates and sick babies. OBJECTIVE: To observe the changes of BAEP of neonates with hyperbilirubinemia, and to investigate the relationship of bilirubin concentration and BAEP. DESIGN: An observation experiment. SETTING: Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA. PARTICIPANTS: Fifty-eight neonates with mild or moderate hyperbilirubinemia exhibiting jaundice within 24 hours after born, who received the treatment in the Department of Pediatrics, the 309 Clinical Division, General Hospital of Chinese PLA between January 2004 and May 2007, were recruited in this study. The involved neonates, 31 boys and 27 girls, had gestational age of 37 to 46 weeks. They had no history of birth asphyxia, and were scored 8 to 10 points when born. Written informed consents of examination and treatment were obtained from the guardians of the neonates. This study was approved by the Hospital Ethics Committee. According to serum total bilirubin value, the neonates were assigned into 3 groups: low-concentration bilirubin group (n =16), moderate-concentration bilirubin group (n =27) and high-concentration bilirubin group (n =15). According to mean daily bilirubin increase, the subjects were sub-assigned into bilirubin rapid increase group (n =39) and bilirubin slow increase group (n =19). METHODS: After admission, all the neonates received drug treatment. Meanwhile, their 116 ears were examined with a myoelectricity evoked potential equipment (KEYPOINT) in latency, wave duration, amplitude and wave shape differentiation of each wave of BAEP. BAEP abnormal type was observed and abnormal rate of BAEP was calculated. MAIN OUTCOME MEASURES: ① Abnormal rate and abnormal type of BAEP. ② Latency of waves Ⅰ, Ⅲ　and Ⅴ, and wave duration of waves Ⅰ to Ⅲ, Ⅲ to Ⅴ, and Ⅰ to Ⅴ. RESULTS: Fifty-eight neonates with mild or moderate hyperbilirubinemia were involved in the final analysis. ①Abnormal type and abnormal rate of BAEP of neonates with hyperbilirubinemia: Among the 116 ears, unilateral or bilateral waves Ⅰ, Ⅲ, Ⅴ still existed. The latency of waves Ⅰ, Ⅲ and Ⅴ was +2.5 s longer than the normal level in 8, 4 and 15 ears, respectively. The wave duration of waves Ⅰ to Ⅲ and waves Ⅲ to Ⅴ was +2.5 s longer than the normal level in 6 and 14 ears, respectively. The wave duration of waves Ⅲ to Ⅴ was longer than that of ipsilateral waves Ⅰ to Ⅲ in 24 ears. The latency difference of wave Ⅴ between two ears was larger than 0.4 ms in 31 neonates with hyperbilirubinemia; The amplitude of wave Ⅴ to that of ipsilateral wave I was lower than 0.5 in 29 neonates. Totally 52 ears were abnormal, and the abnormal rate was 44.8%. One to two months later, 98% abnormal neonates with hyperbilirubinemia recovered. The abnormal rate in the low-, moderate-, and high-concentration bilirubin groups was 37.5%, 44.4% and 53.3%, respectively. ② Comparison of latency and wave duration of each wave of BAEP: Latency of waves Ⅰ, Ⅲ and Ⅴ, and wave duration of waves Ⅰ to Ⅲ and Ⅲ to Ⅴ were gradually prolonged in low-, moderate-, and high-concentration bilirubin groups, but significant difference did not exist between two groups (P > 0.05). ③ There were no significant differences in latency of waves Ⅰ, Ⅲ and Ⅴ, and wave duration of waves Ⅰ to Ⅲ, Ⅲ to Ⅴ and Ⅰ to Ⅴ between bilirubin rapid increase group and bilirubin slow increase group (P > 0.05). CONCLUSION: Auditory acuity and brainstem of neonates with mild or moderate hyperbilirubinemia are damaged to some extent. High-concentration bilirubin causes BAEP abnormality easily. Bilirubin increase and its concentration change are not consistent with nervous lesion degree.     

前庭阵发症脑干听觉诱发电位的特点

目的探讨前庭阵发症(VP)脑干听觉诱发电位(BAEP)的特点。方法对51例VP患者的BAEP结果进行回顾性分析。结果 BAEP异常者40例,异常率为78.4%。与Ⅰ-Ⅲ波峰间期正常的患者相比,Ⅰ-Ⅲ波峰间期延长的患者男性比例高(χ2=4.763,P=0.029),病程显著延长(t=2.469,P=0.021),而平均年龄差异无统计学意义。与Ⅲ-Ⅴ波峰间期正常的患者比较,Ⅲ-Ⅴ波峰间期延长的患者男性比例、平均病程、平均年龄差异均无统计学意义。与Ⅰ-Ⅲ波峰间期耳间差正常的患者比较,Ⅰ-Ⅲ波峰间期耳间差延长的患者病程相对较长(P=0.055),男性有增多趋势(P=0.058),但差异无统计学意义。结论 VP患者BAEP异常以Ⅰ-Ⅲ波峰间期延长为主,且以男性更多见。病程越长,蜗神经越易受累。     

神经电生理监测在原发性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下微血管减压术治疗原发性面肌痉挛的疗效和安全性。方法 回顾性分析2015年10月至2018年10月收治的47例原发性面肌痉挛的临床资料。均经枕下乙状窦后入路神经内镜下进行微血管减压术,25例行脑干听觉诱发电位（BAEP）及侧方扩散效应（LSR）监测（监测组）,22例无术中电生理监测（对照组）。47例术后随访3个月。结果 监测组术前均引出LSR波;剪开硬脑膜后LSR波消失2例;打开桥小脑角池时LSR波消失1例;垫入Teflon棉片减压后LSR波消失19例,LSR波幅明显下降2例;手术结束后仍不消失1例。术中BAEP监测可见Ⅰ、Ⅲ、Ⅴ波波幅降低,潜伏期延长,以Ⅲ波消失、Ⅴ波波幅下降>50%、潜伏期>1 ms居多。术后2周,监测组和对照组总有效率无统计学差异（100.0% vs. 95.5%;P>0.05）。监测组术后并发症发生率（4.0%）明显低于对照组（18.2%;P<0.05）。监测组术后复发率（0%）明显低于对照组（9.1%;P<0.05）。结论 原发性面肌痉挛微血管减压术中应用电生理监测,有助于降低并发症发生率及复发率。     

Influence of extreme head rotations on brainstem auditory evoked potentials (BAEP)

The influence of extreme head rotations on BAEP was studied in 47 patients who had vertebral artery angiogram. Patients with and without unilateral hypoplasia of the vertebral artery (VA) lumen were identified and all patients were further divided into two groups: with and without hypertension. The subjects underwent a BAEP examination in three head positions: neutral position, extreme right and extreme left rotation. In the subgroup of patients with hypertension and unilateral VA hypoplasia, and following the rotation away from the non-hypoplastic vessel a statistically significant decrease in the PV wave amplitude and prolonged PV wave latency was found. Head maneuvers in subjects with normal blood pressure or in hypertensive patients with symmetrical VA did not cause significant changes in BAEP. These results document the effect of head rotation in subjects with potentially impaired collateral flow. An increase in the PV wave latency and decrease in its amplitude may reflect subtle changes in the brainstem perfusion in hypertensive patients. These changes maybe due to a reduced capacity to compensate for dynamic obstruction of VA following the head rotations.     

Changes of brainstem auditory and somatosensory evoked

Objective: to investigate the characteristics and clinical value of evoked potentials in late infantile form of metachromatic leukodystrophy. Methods: Brainstem auditory, and somatosensory evoked potentials were recorded in 6 patients, and compared with the results of CT scan. Results: All of the 6 patients had abnormal results of BAEP and MNSEP. The main abnormal parameters in BAEP were latency prolongation in wave I, inter-peak latency prolongation in Ⅰ-Ⅲ and Ⅰ-Ⅴ. The abnormal features of MNSEP were low amplitude and absence of wave N9, inter-Peak latency prolongation in Ng-N13 and N13-N20, but no significant change of N20 amplitude. The results also revealed that abnormal changes in BAEP and MNSEP were earlier than that in CT. Conclusion: The detection of BAEP and MNSEP in late infantile form of metachromatic leukodystrophy might early reveal the abnormality of conductive function in nervous system and might be a useful method in diagnosis.