面、听神经监测在面肌痉挛显微血管减压术中的意义

目的 探讨面、听神经监测在面肌痉挛显微血管减压术(MVD)中的意义.方法 回顾性分析140例面肌痉挛病人的临床资料,均在面肌诱发肌电图及脑干听觉诱发电位(BAEP)监测下行MVD术.根据监测波形变化指导手术.结果 MVD术前记录到异常诱发电位波形136例,术后随访12～24个月,平均20个月;手术治愈131例(96.3％),好转3例(2.2％),复发2例(1.5％).MVD术前未记录到异常诱发电位波形4例,术中均未发现明确血管压迫,术后症状缓解不明显.术后长期并发症主要是听力下降17例,经对症治疗不同程度恢复15例,未恢复2例;短期并发症包括头痛、头晕、恶心、呕吐等,经过对症治疗均得以缓解.结论 术中面肌诱发肌电图及BAEP监测可客观指导和判断责任血管和减压效果,对提高手术治愈率及减少听力丧失具有较高的实用价值.

Implication of intraoperative monitoring of facial nerve and auditory nerve in microvascular decompression for hemifacial spasm

Objective To investigate the significance of facial nerve and auditory nerve monitoring during microvascular decompression （MVD） for hemifacial spasm. Methods Clinical data of 140 patients with hemifacial spasm were analyzed retrospectively, and the MVD was performed under the monitoring of facial evoked electromyography and brainstem auditory evoked potential （BAEP）. The surgery was guided by the changes of monitoring waveform. Results Abnormal evoked waveform was recorded before MVD in 136 patients, and the patients were followed up for mean period of 20 months, ranged from 12 to 24 months. The hemifacial spasm was cured in 131 patients （96.3%）, improved in 3 （2.2%） and reoccurred in 2 （1.5%）. No abnormal evoked waveform was recorded before MVD in 4 patients, and no vascular compression was found in the operation, and the symptoms showed no obvious improvement postoperation. Postoperative long-term complications were mainly hearing loss in 17 patients, The heating recovered to some degree after symptomatic treatment in 15 and unrecovered in 2. While the short-term complications included headache, dizziness, nausea and vomiting and so on, and all of them were alleviated after the symptomatic treatment. Conclusions The intraoperative monitoring of facial evoked electromyography and BAEP can objectively guide and judge the offending vessels and decompression effects, thus being of more practical value in improving the cure rate and reducing the hearing loss.