异常肌反应在面神经显微血管减压术中的应用

The value of abnormal muscle response monitoring during microvascular decompression surgery forhemifacial spasm

目的探讨异常肌反应（abnormalmuscleresponse，AMR）监测在面神经显微血管减压术（microvascular decompression，MVD）中鉴别责任血管、评估减压效果以及判断预后方面的作用。方法241例典型面肌痉挛患者接受了面神经MVD术中AMR的实时监测，并在术后1周进行疗效评估，分析术中AMR变化与手术预后之间的关系。结果所有241例患者均在术中记录到典型AMR波形，术后第1周217例（90．0％）患者症状完全缓解。AMR消失组175例，其中165例（94．3％）症状缓解；AMR未消失组66例，52例（78．8％）症状缓解。统计学分析显示AMR消失组的疗效明显好于AMR未消失组（P〈0．05）。结论术中AMR监测可辅助判断责任血管，评估减压效果，对提高手术疗效具有较高的应用价值。

Objective Abnormal muscle response（AMR） to the electrical stimulation of a branch of facial nerve is a specific eleetrophysiological feature of primary hemifacial spasm （ HFS ）. Although the correlation between intraoperative AMR findings and postoperative results in patients with HFS has been investigated before, the AMR monitoring has not been employed widely during the microvascular decompression（MVD） surgery. The aim of this study was to evaluate the value of AMR monitoring during MVD, and the correlation between the AMR changes and the clinical outcome. Method This study included 241 cases of MVD. Intraoperative AMR monitoring was performed for each subject. The patients were divided into two groups based on whether the AMR wave disappeared or not following decompression of the facial nerve. Results The AMR disappeared after MVD in 175 patients. Among these 175 patients, 165 （94. 3% ） patients were relieved from HFS 1 week after HFS. Out of the 66 patients in whom the AMR persisted after MVD, 52 （78.8%） patients were relieved. The correlation between intraoperative AMR abolition and HFS relief was statistically significant （P 〈 0. 05 ）. Conclusions Intraoperative AMR monitoring is an effective assistant for a successful MVD for the patient with HFS. It may be helpful in predicting outcomes in short term and identifying offending vessels, so it should be monitored routinely during MVD.