Application Of Intraoperative Electrophysiological Monitoring In Hemifacial Spasm Treated By Microvascular Decompression

Objective:1.In the treatment of hemifacial spasm by microvascular decompression(Microvascular decompression,MVD),intraoperative electrophysiological monitoring technology was used to monitor the changes of lateral diffusion response during surgery and observe its relationship with surgical outcomes.2.Use of intraoperative electrophysiological monitoring in the treatment of hemifacial spasm during microvascular decompression(Microvascular decompression,MVD)to observe the relationship between intraoperative monitoring of auditory evoked potentials and postoperative complications.Methods:1.After systematic study of the First Affiliated Hospital of Shanxi Medical University during the period of 2011.03~2018.02,the clinical data of 107 cases of hemifacial spasm patients treated by microvascular decompression after neurosurgery was started to treat hemifacial spasm after treatment.According to the intraoperative electrophysiological monitoring technology developed in November 2016,it was divided into two groups.2.Through screening,31 cases of hemifacial spasm patients undergoing electrophysiological monitoring during the period from November 2016 to February2018 were treated as monitoring groups;76 cases were treated from 2011.03 to2016.10.The case of a patient with hemifacial spasm was used as a reference group.In the monitoring group,before surgery,the surgeon cut the dural membrane to release cerebrospinal fluid after decompression,the surgeon sharply separated the arachnoid wrapped around the blood vessels and facial nerves,and the surgeon separated the facial nerve and the responsible blood vessels.After the Teflon spacers were placed and the surgeon closed the dura mater,the intraoperative electrical stimulation was performed on the facial mandibular branch in turn in a predetermined sequence to observe and record the myoelectricity on the orbicularis oculi muscle and the orbicularis oculi muscle in real time.Respond to and record the stable period of the side diffusion potential(abbreviated as LSR).After the surgery,compare the presence of lateral diffusion potential with the surgical outcome.The brain stem auditory evoked potential(Brainstem auditory evoked potentials,BAEP)monitoring is to observe the V wave.The volatility and latency changes are based on the consensus of most of the current studies and set a pre-warning value with a decrease of V amplitude by more than 50%.3.The gender of the patients in the monitoring group was 14 males and 25 females.The age range was from 20 to 70 years old.The average age was 50 years old.The medical history period was about 3 to 5 years.There are(4.0 ± 1.5)years.The gender composition of the patient in the reference group was: 39 males and 42 females,and the age range was from 21 to 77.The average age was 50 years,the duration range was 3 to 7.4 years,and the average duration was(5.2±2.2)years..4.The data obtained were analyzed by software: This data was compiled using statistical software SPSS19.0,and the data data studied were represented by n.The analysis between each group of data used the one-factor variance method when P<0.050.At the time,the difference has a statistical significance.Results:1.Of the 31 cases in the surveillance group,24 were missing after the completion of the LSR wave surgery.The LSR waves of the 2 patients disappeared after separating the arachnoid around the blood vessels,20 patients.The LSR waves did not appear after being separated by Teflon gaskets from the divisional responsible blood vessels.Five patients had LSR waves after pressure reduction measures were taken,and two patients who monitored BAEP V waves showed a decrease in amplitude of about 100.In more than 50 percent of cases,these two patients had poor hearing after surgery,one had improved some 3 months after surgery,but the other had become permanent hearing impairment.2.The effect of the monitoring group within a short time is significantly greater than that of the reference group,P<0.05.3.The long-term effect of the monitoring group was greater than the reference group,P<0.05.4.The incidence of postoperative symptoms in the monitoring group was significantly less than the reference,P<0.05.Conclusion:1.Abnormal Muscle Response(AMR),that is,LSR is a characteristic manifestation of primary hemifacial spasm.The disappearance of this wave during surgery often prompts the facial nerve to be effectively decompressed,and the facial muscles reappear after surgery.There may be a noticeable drop in embarrassment.2.BAEP is an important monitoring marker.It mainly reflects the brain stem of the patient during the operation.Through the monitoring of the patient's BAEP during the operation,the state of the patient's auditory nerve can be grasped in real time,so as to avoid the damage of the patient's auditory nerve caused by the operation and make the operation.After hearing loss,the probability of injury is greatly reduced.In the monitoring of BAEP,the hearing loss of the patient can be judged by the amplitude of the V wave.3.It is the results of joint monitoring using FN-MEP and BAEP that greatly promote the long-term and short-term clinical outcome of MVD and greatly reduce the probability of post-operative complications.