面肌痉挛显微血管减压术的诱发肌电图监测和评估

The evaluation of monitoring facial EMG responses during microvascular decompression operation for hemifacial spasm.

目的探讨面神经诱发肌电图对面肌痉挛显微血管减压（ＭＶＤ）治疗的术中监测作用和术后疗效的评估。方法对２６例典型面肌痉挛患者，于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例见ＭＤ－ＯＣ反应消失，术后１周至３个月随访此２１例，痉挛完全消失１２例，明显减退５例，ＭＤ－ＯＣ反应不复存在，部分减轻４例再记录到ＭＤ－ＯＣ反应。另术中、术后均记录到ＭＤ－ＯＣ反应的５例，症状则无改善。结论面神经诱发肌电图用于ＭＶＤ术中监测和预后判断，有其实用价值。

Objective To investigate the role of facial evoked electromyography (EMG) in monitoring in microvascular decompression (MVD) of facial nerve. Methods 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 stimulate the ipsilateral marginal mandibular branch of the facial nerve in the spasm side . The normal side was as control. Results The MD-OC could be recorded preoperatively in all spasm sides, and during the operation, in 21 patients the MD-OC disappeared. At the one week and three months follow-up examination, in 12 of the 21 patients the spasm was absent, and the MD-OC disappeared too. On 9 cases it was much reduced. In 5 cases the MD-OC was present at the end of the operation, the spasm was still present as before craniectomy . Conclusions This technique can be used to monitor facial nerve decompression produres, judged the prognosis and the therapeutic effect of HFS.