电生理联合监测在锁孔入路面神经显微血管减压术中的应用

Application of electrophysiological monitoring in microvascular decompression of the facial nerve via keyhole approach for hemifacial spasm

目的探讨在锁孔入路面肌痉挛(HFS)显微血管减压术(MVD)中,异常肌反应(AMR)和脑干听觉诱发电位(BAEP)联合监测的临床应用价值。方法选取158例HFS患者作为监测组,行术中AMR和BAEP监测;同时设对照组48例,无电生理监测;对两组术后有效率及并发症进行分析。结果监测组患者术后近期有效率为90.51%(143/158),远期达到95.57%(151/158),对照组术后近期有效率为79.17%(38/48),远期87.50%(42/48);两组患者术后近期,远期疗效比较差异有统计学意义(p<0.05),监测组明显优于对照组。监测组患者术后并发症发生率8.87%(14/158)明显低于对照组25.0%(12/48),两组比较差异有统计学意义(p<0.05)。结论锁孔入路MVD是目前治疗HFS确切有效的方法 ,术中使用神经电生理监测有助于鉴别责任血管、减少术后并发症,提高手术疗效。

Objective To investigate the clinical value of electrophysiological monitoring of abnormal muscle response （AMR） and brainstem auditory evoked potential （BAEP） in microvascular decompression （MVD） for hemifacial spasm （HFS） via keyhole approach.Methods A total of 158 patients with HFS were enrolled as the monitoring group.They underwent MVD with electrophysiological monitoring of AMR and BAEP.Another 48 patients with HFS were enrolled as the control group.They underwent MVD without electrophysiological monitoring.The outcome and the incidence of postoperative complications were compared between the two groups.Results The monitoring group had significantly higher short-term and long-term response rates than the control group （90.51％ [143/158] vs 79.17％ [38/48],P ＜ 0.05;95.57％ [151/158] vs 87.50％ [42/48],P ＜ 0.05）.In addition,the monitoring group had a significantly lower incidence of postoperative complications than the control group （8.87％ [14/158] vs 25.0％ [12/48],P ＜ 0.05）.Conclusions MVD via keyhole approach is an effective method for the treatment of HFS.Neuro-electrophysiological monitoring in the MVD can help to identify the responsible blood vessels,reduce postoperative complications,and improve the surgical effect.