| Objective:To analyze the relationship between the timing of lateral spread response disappearance and postoperative efficacy,and further explore the role of lateral spread response in evaluating the decompression effect and predicting curative effect in microvascular decompression treatment of facial spasm.Methods:From June 2015 to August 2018,264 patients with facial muscle spasm received facial nerve microvascular decompression in the department of neurosurgery of the second people’s hospital of guangdong province,andlateral spread response(LSR)was used for neuroelectrophysiological monitoring during the operation.Square wave stimulation was performed on the iliac crest and the mandibular margin,and the myoelectrical responses and disappearance time of the ipsilateral orbicularis and orbicularis muscles were recorded.According to the disappearance time of LSR,it was divided into three groups:early disappearance,immediate disappearance after decompression,delayed disappearance,non-disappearance and recurrence.To observe the postoperative efficacy of facial spasm with microvascular decompression,and to analyze the correlation between LSR monitoring results and postoperative efficacy.Results:In this study group,after all patients received preoperative electrical stimulation,262 patients were able to record the characteristic LSR waveform,2 patients were not extracted,and the extraction rate was 99.2%.During the whole surgical monitoring process,243 cases(about 92%)of LSR disappeared,and 19 cases(about 7.2%)of LSR did not disappear.In the LSR disappearance group,there were 59 cases(22.5%)with early disappearance,78 cases(29.8%)with immediate disappearance,71 cases(27.1%)with delayed disappearance,50 cases(19.1%)without disappearance,and 4 cases(1.5%)with recurrence.There were 57 cases(21.8%)of preoperative disappearance of the mandibular marginal branch,97 cases(37%)of immediate disappearance,75cases(28.6%)of delayed disappearance,31 cases(11.8%)of non-disappearance,and 2 cases(0.8%)of recurrence,with a P value of 0.119 >0.05.In the LSR non-disappearing group,there was no significant difference between the amplitude of the amplitude reduction and the duration of delayed disappearance between the sacral and mandibular branch LSR before and after surgery,indicating that the monitoring value of the two were basically the same.In the observation of short-term efficacy after surgery,95.5% of patients in the LSR disappearance group achieved complete remission and 4.5%achieved different degrees of remission.In the group with no disappearance of LSR,73.7% of patients achieved complete remission and 26.3% achieved different degrees of remission.No remission was found in either group.In the long-term postoperative efficacy,the total effective rate reached 100%,with the cure rate of 97.7%,significant efficiency of 1.9%,and partial remission of0.4%.During the follow-up,most patients achieved complete remission within3 months after surgery,and only 1 patient in this group achieved complete remission within 14 months after surgery,and there was no case without remission.Among them,4 patients had mild postoperative recurrence,which occurred at the 4th,6th,6th and 12 th month of postoperative remission,respectively(2 males and 2 females).The intraoperative LSR disappearance timing and postoperative facial muscle spasm analysis showed that the P values were 0.079>0.05.In the analysis of the degree of amplitude reduction,duration of delay disappearance and efficacy,it was found that the amplitude of LSR in the immediate healing group decreased by more than 50%,the duration of delayed disappearance was within 10 minutes,and the amplitude of the delayed relief group decreased by less than 50%,and the delay disappeared.Duration is greater than 10 minutes.Conclusion:Intraoperative monitoring of the disappearance oflateral spread response helps to judge the decompression effect and prognosis,while the timing of lateral spread response disappearance has no significant effect on postoperative efficacy.The treatment effect of LSR amplitude reduction greater than 50% is better than the treatment effect of amplitude reduction less than 50%.LSR disappears within 10 minutes after the end of the gasket,and the recovery can be achieved after surgery,and the disappearance time is more than 10 minutes,the symptoms may be delayed.However,there was no comparison of postoperative treatment ineffective data.Objective:To analyze the intraoperative facial electromyography(EMG)to determine the association between delayed facial paralysis(DFP)and EMG after microvascular decompression(MVD),and to further evaluate whether intraoperative facial EMG monitoring can predict MVD The occurrence of postoperative DFP.Methods:The clinical data of 264 patients with primary facial spasm(HFS)treated by MVD in Our department from June 2015 to Asgust 2018 in GUANGDONG secondpeople’s hospital were collected.Preoperative routine MRA scanning was performed to exclude secondary facial muscle spasm caused by tumor and other factors,to understand whether there was vascular compression and the degree of compression,to improve the binaural audiometry,and to clarify the preoperative binaural hearing.After the absolute contraindications were excluded,postsigmoid sinus approach was for MVD.During the operation,the us Cadwell intraoperative neuroelectrophysiological monitor was used for the monitoring of lateral muscle electromyography and lateral diffusion.Postoperative spasm relief and facial paralysis were observed,and 37cases(14.1%)of them(16 males and 21 females)were found to have postoperative DFP through telephone or outpatient follow-up,which were classified as DFP group.The remaining patients without DFP were in the non-DFP group,and the relationship between the amplitude of single wave,series wave and burst wave(including orbicularis oculi muscle and orbicularis oris musce)and the total time in the two groups of intraoperative EMG monitoring was statistically analyzed.Results:Of 264 patients with facial spasm,MVD postoperative symptoms immediately complete remission 229 cases(86.7%),delayed31cases(11.7%),4cases of postoperative recurrence of a mild,respectively in ease 4,6,6 and 12 months after surgery(men in 2 cases,2 case of women),the total effective rate of 98.5%,37 patients with late-onset facial paralysis,including 21 cases of female and male 16 cases.There were 15 cases of class H-B II,20 cases of class III,and 2 cases of class IV,with no patients of class V and VI.DFP occurred between 3 and 37 days(mean 10 days)after surgery,in which 34 cases were completely restored to normal,and 3 cases were significantly improved by the last follow-up of this study,without any serious disability.In the DFP group,patients ranged in age from 25 to 68 years(mean 50.2 ±16.9 years)and duration of illness ranged from 1 to 28 years(mean 7.11±6.87 years).The average amplitude and total time of single wave,series wave and burst wave of intraoperative orbicularis oris muscle EMG were 931.2±313.48μV、916.1±172.78μV、924.5±217.31μV、13.6±10.04s、14.8±13.50sand5.31±3.84 s,respectively.The average amplitude and total time of single wave,series wave and burst wave of EMG of orbicularis oculi were810.5±241.90μV 、 797.6±337.31μV 、 782.64±193.19μV 、 13.4±12.75 s 、13.8±11.01 s and 4.46±4.17 s,respectively.In the non-DFP group,patients ranged in age from 27 to 78 years(mean 48.8 years),and duration of diseases ranged from 1 to 27 years(mean 5.1 years).The average amplitude and total time of single wave,series wave and explosion wave of intraoperative orbicularis oris muscle EMG were 864.7±298.85μV 、 851.8±169.51μV 、861.29±201.77μV、16.0±7.84s、15.3±8.51 s and 3.59±2.94 s,respectively.The average amplitude and total time of single wave,series wave and burst wave of EMG of orbicularis oculi were 780.0±126.43μV 、 854.7±202.64μV 、787.7±198.22μV 、 14.9±7.4s 、 11.5±10.11 s and 3.0±2.48 s,respectively.The analysis of the two groups of data showed that the total time P values of the orbicularis oris muscle and orbicularis oculi muscle eruption wave were 0.022 and 0.012,respectively,and both P values were <0.05,indicating that the total time difference of EMG eruption between the two groups was statistically significant.Conclusion:There was a significant difference in the time of intraoperative real-time EMG burst between the DFP group and the non-DFP group,while there was no significant difference in the amplitude between the two group.This indicates that,to some extent,the time of intraoperative real-time EMG burst wave can predict the occurrence of postoperative DFP,which may be caused by the intraoperative stretch of the facial nerve leading to edema and trophoblastic vasospasm,but has nothing to do with permanent facial nerve injury. |
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