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。

The use of monitoring facial electromyography responses during microvascular decompression operations for hemifacial spasm

To investigate the usefulness of monitoring facial evoked electromyography (EMG) in microvascular decompression ( MVD) of facial nerve. Method: In 26 patients with hemifacial spasm ( HFS) , needle electrode was placed in the orbicularis oculi muscle to record EMG response (MD-OC), and a surface electrode was used to stimulate the ipsilateral marginal mandibular branch of the facial nerve before, during and after MVD operation. The normal side was observed as control. Result:The MD-OC could be recorded preoperatively in all affected sides, and during the operation, the MD-OC disappeared in 21 patients . At the one week and three months follow-up examination, in 12 of the 21 patients the spasm were tolally relieved, and the MD-OC disappeared too. 9 cases were markedly improved. In 5 cases the MD-OC was present at the end of the operation, their spasm still present at about the same severity as before. Conclusion: This technique can be used to monitor facial nerve decompression procedures and to judge the prognosis and improvement of the therapeutic effect of HFS.