神经电生理监测在面神经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(HFS)微血管减压术(MVD)中的应用,阐明MVD在提高手术疗效及减少术后并发症发生中的作用。方法: 选取2010年12月-2014年12月接受MVD治疗的HFS患者163例,其中2010年12月-2012年12月收治的73例HFS患者作为对照组,术中无电生理监测;2013年1月-2014年12月收治的90例HFS患者作为监测组,术中行脑干听觉诱发电位/侧方扩散效应/面神经运动诱发电位(BAEP/LSR/FN MEP)监测。对比分析2组减压手术患者术后有效率及听力下降、眩晕和面瘫等并发症发生情况。结果:监测组患者即刻显效率为 52.55%(47 例),轻微面瘫1.11%(1 例),听力下降、眩晕5.56%(5 例);术后随访6~12个月,平均9.6个月,面瘫、听力下降及眩晕均明显改善,手术显效率为65.56% (59 例)。对照组患者即刻显效率为 30.14%(22 例),轻微面瘫13.69%(10 例),听力下降、眩晕23.29%(17 例);术后随访6~12个月,平均9.6个月,面瘫、听力下降及眩晕均明显改善,手术显效率为64.38 % (47 例),2组患者即刻手术显效率比较差异有统计学意义(P<0.05),监测组明显优于对照组;远期疗效比较差异无统计学意义(P>0.05)。2组患者面瘫、听力下降和眩晕等并发症发生率比较差异有统计学意义(P<0.05),监测组优于对照组。结论:LSR 监测能够提高面神经MVD近期疗效,对于远期疗效意义不明显,但术中行BAEP、LSR及FN MEP监测对于责任血管的识别、减压效果和面、听神经的保护具有重要意义。

Application of neural electrophysiological monitoring in facial nerve microvascular decompression

Objective To expore the application of intraoperative neural electrophysiological monitoring in microvascular decompression (MVD)of idiopathic facial spasm (HFS), and to clarify the effect of MVD in increasing the operative efficacy of MVD and decreasing the postoperative complications.Methods From December 2010 to December 2014,163 patients with HFS received MVD were selected;from December 2010 to December 2010,73 patients with facial spasm without electrophysiological monitoring in the operation were used as control group;from January 2013 to December 2014,90 patients with facial spasm with BAEP/LSR/FN MEP monitoring in the operation were used as monitoring group.The postoperative efficiency of MVD and the occurrence of hearing loss,dizziness, facial paralysis and other complications after operation were compared between two groups. Results The immediate efficiency in monitoring group was 52.55% (47 cases), minor facial paralysis 1.11%(1 case),hearing loss and dizziness 5.56% (5 cases).The postoperative follow-up time was 6 to 12 months,an average of 9.6 months; the facial paralysis, hearing loss, and dizziness were significantly improved and the operation efficiency was 65.56% (59 cases).The Immediate efficiency in control group was 30.14% (22 cases), minor facial paralysis 13.69% (10 cases),hearing loss and dizziness 23.29% (17 cases);the postoperative follow-up time was 6 to 12 months,an average of 9.6 months;the facial paralysis,hearing loss,and dizziness were significantly improved, and the operation efficiency was 64.38% (47 cases ). The immediate surgery had statistically significant difference between two groups (P <0.05),and monitoring group was better than control group;the long-term curative effect had no significant difference between two groups (P >0.05).The incidence of facial paralysis, hearing loss and the incidence of complications such as dizziness had statistically significant differences between two groups (P <0.05),and monitoring group was better than control group.Conclusion LSR monitoring can improve the short-term curative efficiency of facial nerve MVD,but the significance for the long-term curative efficiency is not obvious; BAEP, LSR and FN MEP monitoring have great significance in identification of responsibility vessel,judgement of decompression effect and surface and auditory nerves protection.