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术中异常肌反应监测对面神经微血管减压术的指导价值

Value of abnormal muscle response intraoperative monitoring guiding microvascular decompression surgery for hemifacial spasm

    摘要
  • 摘要:
    目的 探讨面神经微血管减压术中减压时异常肌反应（abnormal muscle response，AMR）出现波形混乱和波幅变化现象。
    方法 回顾性分析2018年1月至2019年12月复旦大学附属中山医院神经外科收治的165例行微血管减压术的面肌痉挛患者病例资料，术中进行电生理监测记录AMR波。
    结果 减压过程中AMR出现波形混乱或波幅变化共144例（97.3%），其AMR消失率均高于无变化病例（P=0.011，P=0.001）。AMR消失146例，术后缓解135例（92.5%）；AMR未消失19例，术后缓解11例（57.9%）。AMR消失组患者术后缓解率显著高于AMR未消失组（P=9×10-6）。
    结论 术中减压时AMR出现波形混乱和波幅变化，提示已近责任血管区域，减压后AMR消失患者预后更好。

     

    Abstract:
    Objective To explore the value of the intraoperative waveform and amplitude changes of abnormal muscle response(AMR) on guiding microvascular decompression(MVD)for hemifacial spasm.
    Methods From January 2018 to December 2019, in Department of Neurosurgery, Zhongshan Hospital, Fudan University, 165 cases of patients on whom intraoperative AMR monitoring were performed during MVD were analyzed retrospectively.
    Results During decompression, there were 144 cases(97.3%) with intraoprative waveform or amplitude changes of AMR. The disappearance rate of AMR in patients with waveform or amplitude changes was significantly higher than that without waveform or amplitude changes(P=0.011, P=0.001). AMR disappeared in 146 cases, postoperative remission in 135 cases (92.5%). While AMR did not disappear in 19 cases, postoperative remission in 11 cases (57.9%). There was significant difference in postoperation relief between the AMR disappearance group and the AMR existence group(P=9×10-6).
    Conclusion The waveform and amplitude changes during the decompression suggest that the area is close to the responsible vessels, the AMR is more likely to disappear after the decompression indicating a better prognosis.

     

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