神经电生理监测在三叉神经微血管减压术中的警示作用

Alarming effect of intraoperative neuroelectrophysiological monitoring in microvascular decompression for primary trigeminal neuralgia

目的 探讨术中神经电生理监测在三叉神经微血管减压术（MVD）中的警示作用.方法 选择2014年连续收入第四军医大学西京医院神经外科、初诊为原发三叉神经痛并接受手术患者44例,经术中确诊为原发三叉神经痛患者41例接受MVD.MVD中监测患侧脑干诱发电位（BAEP）、眼和（或）口轮匝肌以及咬肌自发电反应,实时对术者警示报告,术者据此调整操作.结果 术中监测出现异常（潜伏期延长、波幅减低）计23例（56.10％）,累计77次（BAEP 27例次,三叉神经32例次,面神经18例次）.出院时自诉面痛消失26例,缓解15例;面部麻木6例（伴听力减退2例）.面痛消失率和后遗症发生率明显优于无监测对照组（P＜0.05）.结论 术中神经电生理监测,对术者实时警示,有助于保障MVD效果并减少手术并发症.

Objective To explore the alarming effect of intraoperative neuroelectrophysiological monitoring in microvascular decompression （MVD） for primary trigeminal neuralgia.Methods In 2014,a total of 44 patients with an initial diagnosis of primary trigeminal neuralgia were consecutively recruited for surgery.And 41 of them with an intraoperative confirmation of primary trigeminal neuralgia underwent MVD.Intraoperative neuroelectrophysiological monitoring was employed for brainstem auditory evoked potentials （BAEPs）,spontaneous electromyogram for obicularis oculi,obicularisoris and masseter muscles.The realtime alarming report was offered to the operator who adjusted operations accordingly.Results There were abnormal changes in 23 cases （56.10%） with a total of 77 instances （BAEPs 27,trigeminal nerve 32,facial nervel8）.The outcomes were no facial pain （n =26）,pain relief （n =15） and facial numbness （n =6,two with concurrent hearing disturbance）.And the rates of facial pain disappearance and sequela occurrence were much better than those in controls without monitoring.Conclusion Intraoperative neuroelectrophysiological monitoring helps enhance the MVD effect and decrease operative squela through alarming reporting.