Clinical Application Of Neuromonitoring During Microvascular Decompression For Hemifacial Spasm

Objective:The cure rate and vestibulocochlear nerve injury rate after intraoperative neuromonitoring and neuroendoscopy assisted microvascular decompression for idiopathic hemifacial spasm were compared with traditional microvascular decompression,to investigate clinical application of neuromonitoring during microvascular decompression for idiopathic hemifacial.Methods:In this study,a retrospective analysis of 75 patients with idiopathic hemifacial spasm of neurosurgery in the Hebei General Hospital who were treated by Professor Qian Tao from September 2010 to March 2013,37 patients with hemifacial spasm underwent intraoperative neuromonitoring and neuroendoscopy assisted microvascular decompression surgery(monitoring group),and 38 patients underwent traditional surgery(control group),comparing the cure rate and vestibulocochlear nerve injury rate of two groups.Results:1 37 patients in the monitoring group were found offending vessels,37 patients in the control group were found offending vessels.2 Monitoring group:cure rate:97.3%(36 cases),vestibulocochlear nerve injury rate:2.7%(1 case);control group:the cure rate:89.5%(34 patients), vestibulocochlear nerve injury rate:10.5%(4 cases).After the statistical analysis, the difference between the two groups was significant (P<0.05).3 The postoperative effect and follow-up:there are 36 patients who symptom is relieved after 6 months in the monitoring group,including 2 patients with delayed cure;there are 34 patients who symptom is relieved after 6 months in the monitoring group,including 2 patients with delayed cure.75 patients were followed up from 1 month to 32months,with an average 12 months,no patients relapse.437 patients in the monitoring Group were recorded LSR,intraoperative LSR disappeared in 33 cases,4 cases was not disappear.Postoperative symptoms of the patients in the LSR disappeared group were relieved(cure rate:100%);symptoms of 2 patients in the not disappeared group were relieved before discharge,symptoms of 1 patients were relieved after 6 months(cure rate:75%).After the statistical analysis,the effect in the LSR disappeared group is better than not disappeared group (P<0.05).51 patients whose latency of peak V was prolonged more than 1.0 millisecond and 1 patients whose amplitude of peak V changed more than 50% during the operations had vestibulocochlear nerve injury after surgery.Conclusion:1 Intraoperative LSR can help surgeon to determine offending vessels, ensure full decompression,reduce the unnecessary operation of the surgeon and improve the cure rate of surgery,it reduces postoperative invalidation or relapse and postoperative complications because of technical factors,and play a guiding role in the prognosis of patients.2 When intraoperative BAEP changes,it warns instantly the surgeon, remind the current operation of the surgeon,to avoid vestibulocochlear nerve injury because of improper operation of the surgeon,and can effectively reduce the postoperative vestibulocochlear nerve injury rate.3 The neuroendoscopy assisted surgery can reduce the incidence of cranial nerves and brain damage by reducing tissue traction and stimulating the nerves and vessels,and plays a certain role in the protection of the cranial nerves and brain,and reduce the vestibulocochlear nerve injury rate.