Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Niigata University, Niigata, Japan.
Otol Neurotol. 2020 Jun;41(5):704-708. doi: 10.1097/MAO.0000000000002594.
To test whether the threshold of nerve integrity monitor (NIM) responses during facial nerve decompression surgery can predict the postoperative outcome.
Retrospective study.
University hospital.
Twenty peripheral facial palsy patients who underwent transmastoid decompression surgery.
During decompression surgery, thresholds of NIM responses were measured via direct facial nerve stimulation at three sites: the geniculate ganglion (GG), the second genu (2 G), and the stylomastoid foramen.
Facial nerve function was evaluated before and 6 months after surgery using the Yanagihara grading score (maximum score = 40 points). Complete recovery was defined as an improvement of the grading score to ≥ 36 points without synkinesis. Variables including age, sex, disease (Bell's palsy or Ramsay Hunt syndrome), time after onset, Yanagihara grading score, and electroneurography before surgery, and the thresholds of NIM responses during surgery were compared in the complete and incomplete recovery groups. NIM responders were defined as those exhibiting a NIM response of < 1.5 mA at any site. Postoperative Yanagihara grading scores in NIM responders and NIM nonresponders were compared.
No variables differed significantly in the complete and incomplete recovery groups before surgery. NIM response thresholds in the complete recovery group at the GG and the 2nd G were significantly lower than the corresponding thresholds in the incomplete recovery group. The postoperative Yanagihara grading scores of NIM responders were significantly better than those of NIM nonresponders.
NIM responses to intraoperative direct facial nerve stimulation were useful for predicting outcomes after decompression surgery.
测试面神经减压术中神经完整性监测（NIM）反应的阈值是否可以预测术后结果。
回顾性研究。
大学医院。
20 例接受经乳突减压术的周围性面瘫患者。
在减压手术过程中，通过直接面神经刺激在三个部位测量 NIM 反应的阈值：膝状神经节（GG）、第二膝状神经节（2G）和茎乳孔。
使用 Yanagihara 分级评分（最高得分为 40 分）在术前和术后 6 个月评估面神经功能。完全恢复定义为分级评分提高至≥36 分且无联带运动。比较完全和不完全恢复组中年龄、性别、疾病（贝尔麻痹或 Ramsay Hunt 综合征）、发病后时间、术前 Yanagihara 分级评分和电神经图以及术中 NIM 反应的阈值等变量。将在任何部位 NIM 反应<1.5mA 的患者定义为 NIM 反应者。比较 NIM 反应者和 NIM 无反应者的术后 Yanagihara 分级评分。
术前两组间无明显变量差异。完全恢复组 GG 和 2G 的 NIM 反应阈值明显低于不完全恢复组。NIM 反应者的术后 Yanagihara 分级评分明显优于 NIM 无反应者。
术中直接面神经刺激的 NIM 反应有助于预测减压术后的结果。
