Application Of Electrophysiological Monitoring LSR And BAEP In Microvascular Decompression Of Facial Spasm

Objectives: The application of electrophysiological monitoring of lateral diffusion reaction and brainstem auditory evoked potential in microvascular decompression in the treatment of facial spasm.Methods: The People’s Hospital of Xinjiang Uygur Autonomous Region since 2016 were retrospectively analyzed from April to June 2019 treated by microvascular decompression of facial spasm,the clinical data of 101 patients,according to the line whether intraoperative electrophysiological monitoring patients divided into monitoring group and observation group,monitoring groups according to whether postoperative LSR disappear into LSR group and LSR has not disappeared;The LSR disappearance group was divided into LSR disappearance group in advance and LSR disappearance group after decompression.BAEP monitoring:according to the consensus of most studies,the amplitude attenuation of V wave to 50% or the extension of absolute incubation period to 1 ms are set as important warning signals.Comparison was made between the monitoring group and the observation group,the LSR disappearance group and the LSR disappearance group after decompression,and the LSR disappearance group and the LSR disappearance group.Postoperative facial paralysis and hearing impairment were followed up and compared between the monitoring group and the observation group at four time points in the near future,3 weeks,3 months and 1 year.Results: 1.Analysis of efficacy and complications between the monitoring group and the observation group: Comparison and analysis of 3 time nodes in the near term,3 months and 1year after the operation showed statistically significant differences between the monitoring group and the control group(P<0.05),that is,the operative efficacy of the monitoring group was higher than that of the control group at each time node.Statistical analysis showed that the incidence of hearing impairment and facial paralysis complications in the near term,3 weeks,3 months and 1 year after operation in the monitoring group and the observation group were all P < 0.05,and the difference was statistically significant.The incidence of postoperative complications in the monitoring group was lower than that in the control group.2.Relationship between LSR monitoring results and postoperative outcomes:seventy three patients(95.9%)who underwent electrophysiological monitoring had LSR waveforms extracted during the operation.LSR disappeared prematurely in 15 patients.LSR disappeared in 50 patients after decompression.LSR persisted in 5 patients until the end of surgery.Also according to the above time nodes,the P value of surgical efficacy was greater than 0.05 in the LSR disappearance group and the LSR disappearance group after decompression,and there was no difference in postoperative efficacy between the twogroups.The short-term postoperative efficacy of the LSR disappeared group and the LSR not disappeared group was P=0.002,and the short-term postoperative efficacy of the LSR disappeared group was higher than that of the LSR not disappeared group.The efficacy of the two groups was greater than 0.05 3 months and 1 year after the operation,and there was no difference between the two groups.Conclusion:1.Monitoring LSR and BAEP during hemifacial spasm microvascular decompression can improve the surgical efficacy and reduce the incidence of postoperative facial paralysis and hearing impairment complications.2.There was no difference in the postoperative efficacy of LSR disappearance after decompression and LSR disappearance in advance.The short-term efficacy of patients with LSR disappearance was better than those without LSR disappearance,and the long-term efficacy was not different.Therefore,we believed that the disappearance of LSR during the operation may be sufficient rather than necessary for the success of the operation,and the absence of LSR during the operation cannot be regarded as the absolute criterion for the prognosis of patients.