Application Of Abnormal Muscle Response In The Operation Of Hemifacial Spasm

Objective: Poor efficacy and facial nerve-related complications after microvascular decompression(MVD) of hemifacial spasm(HFS) remain unbearable problems for patients.The application of abnormal muscle response monitoring technology can help improve the quality of surgery and shorten the operation time,and facial spasm microvascular decompression surgery is further matured and developed.However,there are still relatively few in-depth studies on the application of AMR technology in HFS and its relationship with clinical prognosis.This study actively explores the factors that affect the curative effect of MVD after the above problems,and excavates the value of AMR monitoring during surgery To study the value of AMR changes during MVD surgery to determine the disappearance or remission of HFS after surgery,and the correlation between AMR and postoperative immediate facial paralysis and delayed facial palsy,with a view to accelerating the surgical process and early provide theoretical support for prevention of postoperative complications.Methods: The relationship between intraoperative AMR changes and postoperative curative effect was analyzed retrospectively in 88 patients,and the curative effect evaluation was performed at 1 week,3 months,and 6 months after operation.After the whole decompression operation was completed,the AMR disappeared into the complete disappearance group,and the AMR amplitude disappeared or decreased by≥80% when the stimulation amount was ≤40 m A after the decompression operation was completed.The differences in the cure rates at 1 week,3 months,and 6 months were analyzed separately,and the correlation between the AMR changes and other factors and postoperative complications such as facial paralysis and delayed facial paralysis were analyzed.Results: The rates of spasticity disappearance at 1 week,3 months,and 6 months after operation were 95.5%(84/88),96.6%(85/88),and 97.7%(86/88).The cure rate of spasticity in the complete disappearance of the AMR group was better than that in the AMR group(P = 0.043 < 0.05);the long-term(June postoperative)effective rate was not significant in the AMR completely disappeared group and the AMR significantly changed group.There was a difference(P = 0.429>0.05),but the long-term effect of the AMR completely disappeared group was better than that of the AMR significant change group(98.8%> 87.5%).There was a statistical difference between the number of responsible vessels and the occurrence of postoperative facial paralysis(P = 0.005< 0.05);there was no statistical difference between the AMR changes and the occurrence of facial paralysis immediately after MVD(P = 0.262>0.05);There was no significant difference in the incidence of facial paralysis(P=0.942>0.05).Conclusions: 1.AMR monitoring is helpful for the operator to identify the responsible blood vessels and to indicate whether the nerve decompression is sufficient.We believe that the premise of the end of MVD surgery is: in the case of fully and fully decompression of the whole facial nerve,decompression is meaningful when AMR amplitude disappears or drops by 80% when the stimulus of AMR is≤40m A.2.Facial paralysis is more likely when the responsible vessels are ≥ 2branches.3.The intraoperative AMR change cannot predict the occurrence of postoperative facial paralysis and delayed facial paralysis.However,AMR monitoring can improve the recognition rate of responsible blood vessels and improve the efficiency of MVD surgery,reduce the damage to non-responsible blood vessels,and further protect the facial nerve and surrounding nourishing blood vessels.4.AMR is used to identify responsible blood vessels during facial spasm surgery and predict the effect of surgery.The important auxiliary tools have reached consensus,but the primary factor affecting the postoperative efficacy and complications such as facial paralysis and delayed facial paralysis is still the operator’s surgical experience and surgical skills.