The Clinical Directive Significance Of Neurophysiological Monitoring In Microvascular Decompression Of Hemifacial Spasm

Background:Facial spasm is a very common clinical disease which is mainly caused by neuropathy. Patients mainly get orbicularis oculi muscle spasm in early stage. However, as the disease progresses continuously, the spasm gradually spread to the entire face. At present, microvascular decompression is mainly adopted in the treatment of hemifacial spasm. It is currently the preferred and most effective method to treat facial spasm, which is accepted both at home and abroad. The indexes monitored in the operation mainly include lateral diffusion effect and brainstem auditory evoked potentials. The lateral diffusion effect mainly refers that the stimulation of the affected side of the marginal mandibular branch of facial nerve may cause the myoelectric potential of the orbicularis oculi muscle potential innervated by the ipsilateral zygomatic branch to be induced. Relevant circumstances could also be recorded timely. Through ipsilateral determination, relevant circumstances could be effectively grasped. In addition, observing the lateral diffusion waveform effect in microvascular decompression also contributes to understanding whether the surgical decompression have achieved ideal effect and whether there are new oppression or responsible vessels omissions. The observation also helps control the adverse consequences caused by human factors and improve the success rate of surgery. The use of brainstem auditory evoked potential can effectively monitored the auditory pathway, so as to better control the rate of postoperative hearing loss. Through clinical research, this research further realizes the clinical value of neural electrophysiological monitoring in microvascular decompression of hemifacial spasm. Objective:In this study, the recognized efficacy criteria and diagnostic criteria are applied to discuss the clinical effect and postoperative complications of neurophysiological monitoring in the treatment of hemifacial Spasm(HFS) with microvascular decompression(MVD), with non-neurophysiological monitoring MVD patients as the control. This study is aimed at comprehensively understanding the clinical directive significance of neurophysiological monitoring in microvascular decompression of hemifacial spasm. Method:Select 163 primary HFS patients underwent MVD surgery, including 73 cases in the control group operated by MVD without neurophysiological monitoring; 90 cases of observation group, using MVD technique and neurophysiological monitoring, mainly including lateral spread response(LSR) and brainstem auditory evoked potential(BAEP) monitoring. Compare the changes of LSR, BAEP, the short-term results of the surgical treatment, the curative effect and the complications of the surgery of the two groups. Result:(1) LSR changes: The LSR of 90 patients had no significant changes before the operation, 76 disappeared after the operation and 14 did not disappeared.(2) BAEP changes: Of 90 patients, the V wave of 8 decreased by more than 50% and 2 disappeared transiently; patients with no BAEP changes during the operation had no loss of hearing after the operation.(3) Curative effect: The immediate effective rate after the operation of the control group is 64.38% and the observation group is 84.44%. The effective rate in 6-12 months after the operation of the control group is 95.89% and the observation group is 97.78%.(4) Complications: Of the 73 patients in the control group, 10 cases of delayed facial paralysis and 17 cases of vertigo and hearing loss were observed. In the observation group, 2 cases of hearing loss, 1 cases of tinnitus, 3 cases of delayed facial paralysis and 2 cases of aseptic meningitis were observed. Conclusion:In the treatment of HFS, MVD is currently the preferred method with the most significant effect. The use of the lateral spread response and brainstem auditory evoked potential monitoring in the operation can effectively improve the operation efficiency, avoid nerve damage, help better grasp the prognosis, reduce the incidence of hearing impairment and benefit the improvement of the success rate of operation and quality.