Dannenbaum Mark, Lega Bradley C, Suki Dima, Harper Richard L, Yoshor Daniel
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77096, USA.
J Neurosurg. 2008 Sep;109(3):410-5. doi: 10.3171/JNS/2008/109/9/0410.
Microvascular decompression (MVD) of the facial nerve is an effective treatment for hemifacial spasm (HFS), but the procedure is associated with a significant risk of complications such as hearing loss and facial weakness. Many surgeons advocate the use of intraoperative brainstem auditory evoked response (BAER) monitoring in an attempt to improve surgical outcomes. The authors critically assessed a large series of patients with HFS who underwent MVD without neurophysiological monitoring.
The authors retrospectively identified 114 consecutive patients, with a history of HFS and without a history of HFS surgery, in whom MVD was performed by a single surgeon without the use of neurophysiological monitoring. Postoperative outcomes were determined by reviewing records and through telephone interviews. At least 1 year of postoperative follow-up data were available for 91 of the 114 patients, and the median follow-up duration in all cases was 8 years (range 3 months-23 years). A Kaplan-Meier analysis showed that 86% of the patients were spasm free at 10 years postoperatively.
There were no surgical deaths or major deficits, and complications included 1 case of postoperative deafness, 1 of permanent subtotal hearing loss, and 10 of delayed facial palsy, 2 of which did not completely resolve at last follow-up. The outcomes, rates of hearing loss, and other complications compared well with those reported in studies in which investigators used intraoperative monitoring.
The results suggest that MVD without neurophysiological monitoring is a safe and effective treatment option in patients with HFS. Although BAER monitoring may be a valuable adjunct to surgery at centers experienced with the modality, the absence of intraoperative monitoring should not prevent neurosurgeons from performing MVD in patients with HFS.
面神经微血管减压术（MVD）是治疗面肌痉挛（HFS）的有效方法，但该手术存在显著的并发症风险，如听力丧失和面部无力。许多外科医生主张术中使用脑干听觉诱发电位（BAER）监测，以试图改善手术效果。作者对一大系列未进行神经生理监测而接受MVD的HFS患者进行了严格评估。
作者回顾性确定了114例连续的患者，这些患者有HFS病史且无HFS手术史，由单一外科医生进行MVD，未使用神经生理监测。通过查阅记录和电话访谈确定术后结果。114例患者中有91例可获得至少1年的术后随访数据，所有病例的中位随访时间为8年（范围3个月至23年）。Kaplan-Meier分析显示，86%的患者术后10年无痉挛。
无手术死亡或严重缺陷，并发症包括1例术后耳聋、1例永久性部分听力丧失和10例迟发性面神经麻痹，其中2例在最后随访时未完全恢复。与使用术中监测的研究报告的结果、听力丧失率和其他并发症相比，情况良好。
结果表明，对于HFS患者，不进行神经生理监测的MVD是一种安全有效的治疗选择。虽然BAER监测可能是在有该技术经验的中心手术的有价值辅助手段，但缺乏术中监测不应阻止神经外科医生对HFS患者进行MVD。
