Park Sang-Ku, Joo Byung-Euk, Park Kwan
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Neurology, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea.
J Korean Neurosurg Soc. 2019 Jul;62(4):367-375. doi: 10.3340/jkns.2018.0218. Epub 2019 Jul 1.
Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.
面肌痉挛（HFS）是由于面神经在其根部出口区（REZ）受到血管压迫所致。在REZ附近对面神经进行微血管减压术（MVD）是治疗HFS的一种有效方法。在HFS的MVD手术中，术中神经生理监测（INM）有两个目的。第一个目的是在MVD手术期间防止损伤神经结构，如前庭蜗神经和面神经，这可以通过脑干听觉诱发电位和面神经肌电图（EMG）的INM来实现。第二个目的是HFS的MVD的独特之处，即评估和优化血管减压的效果。该目的主要通过监测被称为侧方扩散反应（LSR）的异常面神经EMG来实现，部分也可通过Z-L反应、面部F波和面部运动诱发电位来实现。基于上述关于INM的信息，HFS的MVD可被认为是一种更安全有效的治疗方法。
