Intraoperative monitoring of facial EMG responses during microvascular decompression for hemifacial spasm. Prognostic value for long-term outcome: a study in a 33-patient series
Intraoperative monitoring of facial EMG responses during microvascular decompression for hemifacial spasm. Prognostic value for long-term outcome: a study in a 33-patient series
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DOI：
10.1080/02688690120105101
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发表时间：
2001-12-01
影响因子：
1.1
通讯作者：
Vial, C
中科院分区：
文献类型：
--
作者：
Hatem, J;Sindou, M;Vial, C
侧扩反应（LSR）是面肌痉挛（HFS）的一种电生理特征，可在手术过程中记录。这项工作的目的是评估的持续性或抑制的LSR在微血管减压术（MVD）程序的面神经结束的预后价值。33例HFS患者，已经发展了5.5年，接受了术中EMG的MVD。监测需要在额肌和颏肌中放置针头。刺激面神经的下支或上级支后记录反应，以寻找异常的ephaptic LSR。所有患者均存在术前异常LSR。在23例患者中，LSR随着血管减压而消失，并且在闭合时不存在。在这些患者中，20例被认为临床治愈，3例在3个月随访时仍存在轻度/中度痉挛。在后期随访时，22例患者无痉挛。1例患者在第10个月时痉挛复发。相反，10例患者在闭合时LSR持续异常。其中7例在早期随访（平均3个月）时治愈，另3例在晚期随访（12 ~ 36个月）时痉挛消失。LSR监测的预后价值值得怀疑;在MVD结束时出现持续LSR的患者中可能获得良好的临床结果。延迟治愈有力地支持了HFS不仅是由于细长动脉对面神经根出口区的机械脉动，而且还由于神经血管压迫产生的神经脱髓鞘和/或面运动核过度活跃的假设。
Lateral spread responses (LSR), an electrophysiological characteristic of hemifacial spasm (HFS), can be recorded during surgery. This work aims at evaluating the prognostic value of the persistence or suppression of the LSR at the end of the microvascular decompression (MVD) procedure of the facial nerve. Thirty-three patients with HFS, which had been evolving for 5.5 years, underwent MVD with intraoperative EMG. Monitoring required the placement of a needle in the frontalis and mentalis muscles. Responses were recorded after stimulation of inferior or superior branches of the facial nerve to search for abnormal ephaptic LSR. Preoperative abnormal LSRs were present in all patients. In 23 patients, LSR disappeared with vascular decompression and was not present upon closure. Among those patients, 20 were considered clinically cured and three still presented with mild/moderate spasm at 3-month follow-up. At late follow-up, 22 patients were free of spasm. One patient had recurrence of spasm at month 10. On the contrary, 10 patients had persistent abnormal LSR upon closure. Among those, seven were cured at early follow-up (3 months on average), whereas spasm disappeared at late follow-up (12 to 36 months) in the other three patients. The prognostic value of LSR monitoring is questionable; a good clinical result may be obtained in patients who presented with persistent LSR at the end of MVD. Delayed cure strongly supports the hypothesis that HFS is not only due to the mechanical pulsations of the elongated artery against the root exit zone of the facial nerve, but also to demyelination of the nerve and/or hyperactivity of the facial motornucleus generated by the neurovascular compression.