肌电图引导下的神经梳理术使微血管减压术治疗伴有持续性异常肌肉反应的面肌痉挛更加成功。
Electromyographically Guided Nerve Combing Makes Microvascular Decompression More Successful in Hemifacial Spasm with Persistent Abnormal Muscle Response.
作者信息
Zhang Xin, Zhao Hua, Zhu Jin, Tang Yin-Da, Ying Ting-Ting, Yuan Yan, Li Shi-Ting
机构信息
Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for diagnosis and treatment of cranial nerve diseases, Shanghai Jiao Tong University, Shanghai, China.
Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for diagnosis and treatment of cranial nerve diseases, Shanghai Jiao Tong University, Shanghai, China.
出版信息
World Neurosurg. 2017 Jun;102:85-90. doi: 10.1016/j.wneu.2017.02.091. Epub 2017 Feb 27.
BACKGROUND
Microvascular decompression (MVD) of the facial nerve monitored intraoperatively by abnormal muscle response (AMR) activity is a common treatment for hemifacial spasm. AMR frequently persists after MVD, however, for which electromyography (EMG)-guided nerve combing sometimes is recommended. Because no research regarding the success of EMG-guided nerve combing has been published, we compared the effectiveness of nerve combing after MVD with simple MVD in cases including persistent AMR.
METHODS
A retrospective study of 127 cases of hemifacial spasm treated with persistent AMR after MVD treatment occurring between January 2011 and June 2015 was conducted. Among the 127 total cases, EMG-guided nerve combing was used in 72 patients and simple MVD in 55 patients.
RESULTS
For simple MVD, success rates at 1 day, 7 days, 1 month, 3 months, and 1 year after surgery were all approximately 80%; the success rates of MVD with nerve combing were significantly greater (P < 0.05) than those of simple MVD, by 15.83%, 15.4%, 17.22%, 17.65%, and 17.65%, respectively. The incidence rates of facial palsy in simple MVD were 12.73%, 14.55%, 10.91%, 3.64%, and 1.82%, respectively; those in the nerve combing group were 27.78% (P < 0.05 vs. simple MVD), 33.33% (P < 0.05), 25.00% (P = 0.05), 5.55% (P > 0.05), and 2.78% (P > 0.05), respectively.
CONCLUSIONS
In cases of hemifacial spasm with persistent AMR after MVD, EMG-guided nerve combing significantly improved the success rate of the operation. Although it also significantly increased the incidence of postoperative facial palsy over the short term (up to 1 week), incidences in the long term were not significantly different.
背景
术中通过异常肌肉反应（AMR）活动监测面神经的微血管减压术（MVD）是治疗面肌痉挛的常用方法。然而，MVD术后AMR常常持续存在，对此有时建议采用肌电图（EMG）引导下的神经梳理术。由于尚未发表关于EMG引导下神经梳理术成功率的研究，我们比较了在包括持续性AMR的病例中，MVD术后神经梳理术与单纯MVD的有效性。
方法
对2011年1月至2015年6月期间接受MVD治疗后出现持续性AMR的127例面肌痉挛病例进行回顾性研究。在这127例病例中，72例患者采用了EMG引导下的神经梳理术，55例患者采用了单纯MVD。
结果
对于单纯MVD，术后1天、7天、1个月、3个月和1年的成功率均约为80%；神经梳理术联合MVD的成功率分别比单纯MVD显著提高（P < 0.05）15.83%、15.4%、17.22%、17.65%和17.65%。单纯MVD中面神经麻痹的发生率分别为12.73%、14.55%、10.91%、3.64%和1.82%；神经梳理术组分别为27.78%（与单纯MVD相比，P < 0.05）、33.33%（P < 0.05）、25.00%（P = 0.05）、5.55%（P > 0.05）和2.78%（P > 0.05）。
结论
在MVD术后出现持续性AMR的面肌痉挛病例中，EMG引导下的神经梳理术显著提高了手术成功率。虽然它也在短期内（长达1周）显著增加了术后面神经麻痹的发生率，但长期发生率并无显著差异。
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