异常肌反应与脑干听觉诱发电位联合监测下神经内镜辅助显微血管减压术治疗偏侧面肌痉挛的临床效果

Effect of neuroendoscopy-assisted microsurgical vascular decompression under combined monitoring of abnormal muscle response and brainstem auditory evoked potential in the treatment of hemifacial spasm

摘要:

目的 探讨异常肌反应（AMR）与脑干听觉诱发电位（BAEP）联合监测下神经内镜辅助显微血管减压术（MVD）治疗偏侧面肌痉挛（HFS）的效果及其对血清髓鞘碱性蛋白（MBP）和神经元特异性烯醇化酶（NSE）的影响。方法 前瞻性选取2019年1月－2023年12月该院收治的HFS患者110例，采用随机数表法分为对照组（n = 55）和研究组（n = 55）。对照组采取神经内镜辅助MVD治疗，研究组采取AMR与BAEP联合监测下神经内镜MVD治疗。比较两组患者治疗效果、手术前后血清MBP和NSE水平、面神经功能分级、面神经电生理参数（复合肌肉动作电位、瞬目反射波幅R1、R2和R2'）、生活质量［偏侧面肌痉挛评分量表（HFS-8）评分］和睡眠质量［匹茨堡睡眠质量指数（PSQI）评分］，以及并发症发生率。结果 研究组总有效率为94.55%（52/55），明显高于对照组的80.00%（44/55），差异有统计学意义（P < 0.05）；术后1和3 d，研究组血清MBP和NSE水平明显低于对照组，差异均有统计学意义（P < 0.05）；术后6个月，研究组面神经功能分级明显优于对照组，瞬目反射波幅R1、R2和R2'明显低于对照组，复合肌肉动作电位明显高于对照组，差异均有统计学意义（P < 0.05）；术后6个月，研究组HFS-8评分和PSQI评分明显低于对照组，差异均有统计学意义（P < 0.05）；两组患者并发症发生率比较，差异无统计学意义（P > 0.05）。结论 AMR与BAEP联合监测下神经内镜辅助MVD治疗HFS的效果显著，能改善神经功能，提高睡眠质量和生活质量，且有较高的安全性。

Abstract:

Objective To investigate the effect of neuroendoscopy-assisted microsurgical vascular decompression (MVD) on hemifacial spasm (HFS) under the combined monitoring of abnormal muscle response (AMR) and brainstem auditory evoked potential (BAEP), and its impact on serum myelin basic protein (MBP) and neuron-specific enolase (NSE).Methods 110 patients with HFS from January 2019 to December 2023 were prospectively selected and divided into a control group (n = 55) and study group (n = 55) according to the random number table method. The control group received neuroendoscopy-assisted MVD treatment, while the study group received neuroendoscopy-assisted MVD treatment under the combined monitoring of AMR and BAEP. The therapeutic effects, the levels of serum MBP and NSE, facial nerve function grading, electrophysiological parameters of facial nerve (compound muscle action potential, blink reflex wave amplitude R1, R2, and R2'), quality of life [hemifacial spasm scale (HFS-8) score], and sleep quality [Pittsburgh sleep quality index (PSQI) score] before and after surgery, and complication rates of the two groups were compared.Results The total effective rate of the study group was 94.55% (52/55), which was higher than that of the control group (80.00%, 44/55), the difference was statistically significant (P < 0.05). At 1 and 3 d after operation, the levels of serum MBP and NSE in the study group were lower than those in the control group, the differences were statistically significant (P < 0.05). At 6 months after surgery, the facial nerve function grading of the study group was better than that of the control group, the blink reflex wave amplitudes R1, R2 and R2' were lower than those of the control group, and the compound muscle action potential was higher than that of the control group, the differences were statistically significant (P < 0.05). At 6 months after surgery, the HFS-8 score and PSQI score of the study group were lower than those of the control group, the difference was statistically significant (P < 0.05). The difference in the incidence rate of complications between the two groups was not statistically significant (P > 0.05).Conclusion The combined monitoring of AMR and BAEP under neuroendoscopy-assisted MVD treatment of HFS patients has significant effects, improving patients' neurological function, improving their sleep quality and quality of life, and has high safety.