面肌痉挛微血管减压术中电生理监测的应用价值

Applied value of intraoperative electrophysiological monitoring in microvascular decompression for hemifacial spasm

目的探讨术中听觉脑干诱发电位（BAEP）及面肌旁路传导反应（LSR）在面肌痉挛微血管减压手术中的应用价值和意义。方法将2003年1月～2005年7月收治的49例面肌痉挛病人归为A组（术中无电生理监测），2005年8月～2007年3月收治的56例归为B组（术中行BAEP及LSR电生理监测），对比分析两组手术的有效率及听力下降、眩晕等并发症发生情况。结果A组术后即刻手术有效率为95．9％（47例），发生面瘫6例（12．2％），眩晕4例（8．2％），听力下降伴耳鸣4例（8．2％）；术后12个月，除1例仍有听力下降伴耳鸣外。眩晕、听力下降、面瘫均改善，手术有效率为89．8％（44例）。B组术后即刻手术有效率为94．6％（53例），发生面瘫1例（1．8％）。无眩晕、听力下降及耳鸣发生；术后12个月，面瘫改善，手术有效率为91．1％（51例）。两组手术有效率差异无统计学意义（P〉0．05），而面瘫、眩晕、听力障碍发生率差异具有统计学意义（P〈0．05）。结论在微血管减压手术治疗面肌痉挛过程中．联合应用BAEP、LSR等神经电生理技术跟踪手术进程，能较好控制听力损伤并发症的发生，及判断面神经减压效果。

Objective To explore the applied value of intraoperative electrophysiology monitoring, including brain stem auditory evoked potential （BAEP） and lateral spread response （LSR） in microvascular decompression for hemifacial spasm. Methods Forty-nine patients with hemifacial spasm treated from Jan, 2003 to Jul, 2005 without intraoperative electrophysiological monitoring were classified as group A and 56 from Aug, 2005 to Mar, 2007 with BAEP and LSR monitoring as group B. The surgical success rate and complications such as hearing impairment, vertigo and facial paralysis of two groups were statistically compared. Results Immediately after the surgery, the cure rate of operation was 95.9% （47 cases） and 94.6% （53 cases） in group A and group B, respectively. In group A, facial paralysis occurred in 6 cases （12.2%）, vertigo in 4 （8.2%）, and hearing impairment with tinnitus in 4 （8.2%）, by 12 months after the operation, all complications improved except hearing impairment and tinnitus in one. In group B, only one patient has facial paralysis with recovery in 12 months. By 12 months, the surgical success rate was 89.8% （44 cases） and 91.1% （51 cases） in group A and group B respectively, with no statistical difference between two groups （P〉0.05）, but there were statistical differences in complications （P〈0.05）. Conclusion During microvascular decompression for hemifacial spasm, intraoperative electrophysiological monitoring is useful for avoidance of hearing impairment and judging efficacy of facial nerve decompression.