Effect Of Electrophysiological Monitoring On Surgical Outcome In Hemifacial Spasm

Objective: To explore the value of neurophysiological monitoring in microvascular decompression in the treatment of primary hemifacial spasm(HFS).Materials and Methods: 1.121 cases with primary hemifacial spasm were collected,who were treated and received microvascular decompresslon from 2016 to 2018.In the department of neurosurgery at the Dalian central hospital of Dalian medical university,they were divided into two groups.2.There is no absolute difference between the two groups in the basic situation.We only take whether electrophysiological monitoring is performed during the operation as the grouping factor,and whether the reason of application is whether electrophysiological technicians could participate in it as the benchmark,and distribute it completely randomly.The control group was treated with microvascular decompression of facial nerve under microscope,while the observation group was treated with microvascular decompression of facial nerve,and the AMR wave-shape was continuously monitored during the operation.Before operation,after release of cerebrospinal fluid,after acute separation of arachnoid,after separation of facial nerve and responsible vessel and placement of Teflon gasket,electrical stimulation of the mandibular marginal branch of facial nerve was performed after closure of dura mater,and the electromyographic response on orbicularis oculi muscle was recorded.The time of disappearance of AMR waveform was recorded.The disappearance of AMR was compared with the effect of operation.3.The observation group contained 17 male patients,35 female patients,the average age was(45±8.13)years old,the average course of disease was(4.6±1.5)years.There were 25 male patients,44 female patients in control group,the average age was(40±12.11)years old,the average course of disease was(5.8±2.1)years.SP22 19.0 statistical software was used,and the test of ?2 was included.Set p<0.05 with statistical significance.Results: 1.There were 52 cases in the observation group,the immediate effective rate was 86.54%,69 in the control group,and the immediate effective rate was 63.77%.The long-term effective rate was 96.15% in the observation group,94.20% in the control group,and the statistical comparison was P > 0.05.2.Among the 52 patients in the observation group,the AMR waveform completely disappeared during the operation in 40 cases,and there were 12 patients with low amplitude waveform remaining.The immediate effective rate in the AMR disappearance group was 95.00%,which was significantly higher than that in the residual group(58.33%)which was indicated by chi-square test(P < 0.05).The long-term efficacy of the same comparison is not very significant,statistical P > 0.05.Conclusion: Electrophysiological monitoring of AMR wave changes in microvascular decompression of facial nerve can effectively assist the surgeon to quickly find the responsible vessels and determine the condition of facial nerve decompression.At the same time,it can effectively improve the immediate efficiency after operation,shorten the course of the disease and alleviate the patient's pain.On the other hand,the change of AMR can also guide the surgeon to judge the immediate curative effect after operation,and better assist the surgeon to communicate with patients after operation and guide follow-up treatment.