Zhu Hong-wei, Li Yong-jie, Zhuang Ping, Li Ji-ping, Ma Kai
Beijing Institute of Functional Neurosurgery, Capital University of Medical Sciences, Beijing 100053, China.
Zhonghua Yi Xue Za Zhi. 2008 Oct 28;88(39):2767-70.
To investigate the value of abnormal muscle response (AMR) monitoring during microvascular decompression (MVD) for hemifacial spasm (HFS) and compare the outcomes of the patients undergoing AMR or not.
234 HFS patients, aged (45.2 +/- 12.5) (25 - 76), undergoing MVD were randomly divided into 2 groups:199 of them underwent AMR monitoring intra-operatively and 35 not. No muscle relaxant was used. The zygomatic branch of the facial nerve was stimulated electrically and the AMR of the ipsilateral mental muscle was recorded. The relationship between AMR monitoring results and final surgical outcome was analyzed.
Before incision of dura mater, all patients showed characteristic AMR of HFS. AMR disappeared in 165 patients (82.9%) after MVD of the facial nerve root. HFS disappeared shortly after operation in 144 of the 165 patients with disappearance of AMR, and only in 8 of the 34 patients with persistent AMR. Follow-up lasting for more than 1 year showed that HFS disappeared in 157 of the 181 patients of the AMR group, and in 24 of the 35 patients who had not undergone AMR monitoring during operation.
Helping differentiate the responsible vessel, to assess the effect of decompression, and to predict the postoperative course of MVD, AMR monitoring improves the long-term outcome of HFS treated with MVD.
探讨微血管减压术（MVD）治疗面肌痉挛（HFS）时异常肌肉反应（AMR）监测的价值，并比较进行AMR监测与未进行AMR监测患者的手术效果。
将234例年龄为（45.2±12.5）岁（25 - 76岁）接受MVD治疗的HFS患者随机分为两组：其中199例术中进行AMR监测，35例未进行。术中未使用肌肉松弛剂。电刺激面神经颧支，记录同侧颏肌的AMR。分析AMR监测结果与最终手术效果的关系。
在硬脑膜切开前，所有患者均表现出HFS的特征性AMR。面神经根部MVD后，165例患者（82.9%）的AMR消失。AMR消失的165例患者中，144例术后HFS立即消失，而AMR持续存在的34例患者中仅8例术后HFS消失。随访1年以上显示，AMR组181例患者中有157例HFS消失，术中未进行AMR监测的35例患者中有24例HFS消失。
AMR监测有助于鉴别责任血管、评估减压效果及预测MVD术后病程，可改善MVD治疗HFS的长期疗效。
