Application Of Intraoperative Neurophysiological Monitoring In Microvascular Decompression For Cranial Nerve Diseases

Objective: Comparing the clinical date of patients suffer cranial nerve disease with microvascular decompression apply or don’t apply of intraoperative neurophysiological monitoring,to evaluate the application of intraoperative neurophysiological monitoring in operative time,surgical efficiently,complications and the relapse rate,and then discusses the necessity of intraoperative neuromonitoring in cranial nerve disease with microvascular decompression for clinical decision.Methods: Collected the date of the same neurosurgeon performed the surgery of microvascular decompression in patients who suffered primary cranial nerve disease in the first hospital affiliated to Dalian medical university from August 2017 to December 2020,all patients were exposed to Nuclear Magnetic Resonance Imaging and were excluded from the situation of secondary morbidity,there were 110 cases of trigeminal neuralgia(4 patients had bilateral trigeminal neuralgia),85 cases suffered hemifacial spasm,glossopharyngeal neuralgia in 5 cases.During the operation,the patients of trigeminal neuralgia were monitored the brainstem auditory evoked potential(BAEP),and the freedom of electromyogram,the patients of hemifacial spasm were monitored transverse diffusion response(AMR),BAEP and free EMG of frontal and mental muscles,the patients who suffered glossopharyngeal neuralgia were monitored BAEP and EMG.A total of 100 patients were selected as the control group who did not receive intraoperative electrophysiological monitoring from August 2017 to July 2019,and 100 patients were selected as the experimental group who received intraoperative electrophysiological monitoring from August 2019 to December 2020.Clinical figures(comprising age of patients,gender,left and right sides,course of disease,responsible lesions,operative time,follow-up time),surgical effect,complications and recurrence were recorded precisely.We used the software of SPSS to analysis the data,and P < 0.05 was considered statistically significantResult: In the homogenous samples with no statistically significant differences in cranial nerve type,age,gender,course of disease and lesion,the experimental group needed more less operative time,and the P was 0.016,P < 0.05,the discrepancy of the experimental group and the matched group in the time of microvascular decompression was statistically significant.The P of curative effect of immediately postoperatively and 3 months after surgery of the experimental group and the control group were 0.000 and 0.869,indicating that the use of intraoperative neurophysiological monitoring can significantly improve the immediate postoperative curative effect,but the long-term surgical effect does not different from the control group.The experimental group’s and the control group’s effective rates were 97.0% and 94.0%,and the difference of effective percentage was not statistically significant.The intraoperative neurophysiological monitoring did not affect the operative efficiency.Experimental group and control group in the incidence of postoperative cranial nerve injury was 14.0%,35.0%,P(0.001)< 0.05,the discrepancy of two groups was statistically significant,and intracranial bleeding and other complications(hydrocephalus,benign intracranial pressure increased,lower cranial pressure syndrome,intracranial infection,aseptic meningitis and cerebrospinal fluid leakage,intracranial pneumatosis,incision complications)P value of 0.172,0.728 is not statistically significant,brain contusion complication does not occurred,the date showed that the experiment was lower than the matched group in the incidence of postoperative cranial nerve injury,and intracranial hemorrhage,cerebral contusion and other complications,such as no difference.The recurrence rate of the experimental group and the matched group in 3 months after operation was 0.0% and 6.0%,with a P value of 0.038 and a significant discrepancy of P < 0.05,indicating that the experimental group had a lower recurrence rate.Conclusion: Intraoperative neurophysiological monitoring in microvascular decompression of cranial nerve diseases has important guidance and the warning role,can curtail the surgical operation time,improve the workpiece ratio,increase the rate of surgery immediately fine performance,but no significant changes,for efficient for long-term(> 3months)and no improvement effect and can reduce the postoperative complications,cranial nerve injury to complications such as postoperative intracranial hemorrhage in the brain damage,no significant correlation,can reduce the postoperative recurrence rate.