CAJ | 학술논문

目的探讨显微血管减压手术中,辅以异常肌反应电生理监测治疗面肌痉挛的临床应用价值.方法北京协和医院于2009至2010年对47例原发性面肌痉挛患者均采用显微血管减压手术,手术过程中间断电刺激患侧面神经颧支,记录同侧口轮匝肌肌电位的变化情况.手术后随诊5～22个月.结果 47例患者在手术开始时,均可在痉挛侧记录到异常肌反应信号.在手术过程中的不同阶段里,42例患者痉挛侧异常肌反应信号消失(其中4、9及29例患者的异常肌反应信号分别于剪开硬膜时、分离蛛网膜时、垫开责任血管时消失)；全部42例患者术后未再发作面肌痉挛.5例患者异常肌反应波形在手术结束时仍未消失；随访中发现其中2例患者的面肌痉挛症状完全消失,3例患者痉挛程度较术前明显缓解.结论显微血管减压手术中辅以异常肌反应电生理监测,可帮助判定责任血管,提高手术的疗效.
목적 탐토현미혈관감압수술중,보이이상기반응전생리감측치료면기경련적림상응용개치.방법 북경협화의원우2009지2010년대47례원발성면기경련환자균채용현미혈관감압수술,수술과정중간단전자격환측면신경권지,기록동측구륜잡기기전위적변화정황.수술후수진5～22개월.결과 47례환자재수술개시시,균가재경련측기록도이상기반응신호.재수술과정중적불동계단리,42례환자경련측이상기반응신호소실(기중4、9급29례환자적이상기반응신호분별우전개경막시、분리주망막시、점개책임혈관시소실)；전부42례환자술후미재발작면기경련.5례환자이상기반응파형재수술결속시잉미소실；수방중발현기중2례환자적면기경련증상완전소실,3례환자경련정도교술전명현완해.결론 현미혈관감압수술중보이이상기반응전생리감측,가방조판정책임혈관,제고수술적료효.
Objective To explore the clinical efficacy of microvascular decompression plus intraoperative monitoring of abnormal muscle response in the treatment of hemifacial spasm.Methods Between 2009 and 2010,a total of 47 patients underwent microvascular decompression for hemifacial spasm.There were 15 males and 32 females with an age range 23 -70 years old.During operations,intermittent electrical pulses were applied to stimulate the zygomatic branch of facial nerve at the spasm side.And evoked potentials were monitored in orbicularis oris.All patients were followed up for 5 - 22 months.Results The abnormal muscle responses were recorded pre-operatively in all 47 patients at the spasm side.In 42 patients,the abnormal muscle responses disappeared at the different stages of operations (4 while opening dura,9 while dissecting arachnoid membrane and 29 while separating responsible vessels).All 42 patients were cured during the follow-up period.In the remaining 5 patients,the abnormal muscle response were still recorded even at the end of operations.Two of 5 patients were free from spasm during the follow-up period while the symptoms of other 3 patients became obviously relieved.Conclusion The combined approaches of microvascular decompression and intraoperative monitoring of abnormal muscle response may assist the identification of responsible vessels and improve the outcomes of hemifacial spasm.