【摘要】 目的 比较神经电生理监测下显微镜和内镜微血管减压术治疗面肌痉挛的临床效果。方法 选择新乡医学院第一附属医院神经外科2014年12月至2020年6月收治的106例面肌痉挛患者为研究对象，按治疗方法将患者分为观察组(n=52)和对照组(n=54)。2组患者术前均常规行三维时间飞跃法磁共振体层血管造影初步判断出责任血管；对照组患者采用神经电生理监测下显微镜微血管减压术治疗，观察组患者采用神经电生理监测下内镜微血管减压术治疗。比较2组患者术前责任血管判断的准确性和疗效，分析术前、术中电生理监测结果与疗效的关系；比较2组患者术后并发症发生率。结果 对照组患者术前判断责任血管为小脑前下动脉38例，小脑后下动脉15例，椎基底动脉1例；术中确定责任血管为小脑前下动脉38例，小脑后下动脉14例，小脑后下动脉和椎动脉1例，椎基底动脉1例；术前责任血管判断准确率为98.1%(53/54)。观察组患者术前判断责任血管为小脑前下动脉34例，小脑后下动脉16例，椎基底动脉2例；术中确定责任血管为小脑前下动脉33例，小脑后下动脉16例，小脑前下动脉和小脑后下动脉1例，椎基底动脉2例；术前责任血管判断准确率为98.0%(51/52)。2组患者术前责任血管判断准确率比较差异无统计学意义(χ~2=6.914,P>0.05)。对照组患者治疗有效率为92.59%(50/54),观察组患者治疗有效率为94.23%(49/52);2组患者治疗有效率比较差异无统计学意义(χ~2=0.115,P>0.05)。对照组38例患者术中侧方扩散反应(LSR)-1和LSR-2均消失，术后均临床治愈；观察组40例患者术中LSR-1和LSR-2均消失，术后均临床治愈。对照组12例术中LSR-1或者LSR-2完全消失且另一LSR波幅降低50%以上患者中，2例治愈，10例明显缓解；观察组9例LSR-1或者LSR-2完全消失且另一LSR波幅降低50%以上患者中，3例治愈，6例明显缓解。对照组术中LSR-1和LSR-2均未消失4例患者中，3例部分缓解，1例无缓解；观察组术中LSR-1和LSR-2均未消失3例患者中，2例部分缓解，1例无缓解。对照组患者术后并发症发生率为9.25%(5/54),观察组患者术后并发症发生率为3.84%(2/52);2组患者术后并发症发生率比较差异无统计学意义(χ~2=1.259,P>0.05)。结论 神经电生理监测下显微镜和内镜微血管减压术治疗面肌痉挛的有效性和安全性均较好，且2种手术方式的有效性和安全性无显著性差异；神经电生理监测LSR-1和LSR-2可指导正确判断责任血管和适时终止手术，为手术疗效提供客观判断依据。更多还原

【Abstract】 Objective To compare the clinical effects of microscopic and endoscopic microvascular decompression under neurophysiological monitoring in the treatment of hemifacial spasm.Methods A total of 106 patients with hemifacial spasm admitted to Department of Neurosurgery of the First Affiliated Hospital of Xinxiang Medical University from December 2014 to June 2020 were selected as the research objects, and they were divided into observation group(n=52) and control group(n=54) according to the treatment method.All patients in the two groups underwent three-dimensional time leap magnetic resonance tomography angiography to judge the responsible vessels; the patients in the control group were treated with microscopic microvascular decompression under neuroelectrophysiological monitoring, and the patients in the observation group were treated with endoscopic microvascular decompression under neuroelectrophysiological monitoring.The accuracy of preoperative judgment of responsible vessels and curative effect of patients were compared between the two groups, and the relationship between preoperative and intraoperative electrophysiological monitoring results and curative effect was analyzed; the incidence of postoperative complications of patients between the two groups were compared.Results In the control group, the responsible vessels were judged as anterior inferior cerebellar artery before operation in 38 patients, posterior inferior cerebellar artery in 15 patients and vertebrobasilar artery in 1 patient; the responsible vessels were identified as anterior inferior cerebellar artery during operation in 38 patients, posterior inferior cerebellar artery in 14 patients, posterior inferior cerebellar artery and vertebral artery in 1 patient and vertebrobasilar artery in 1 patient; the accuracy of preoperative judgment of responsible vessels was 98.1%(53/54).In the observation group, the responsible vessels were judged as anterior inferior cerebellar artery before operation in 34 patients, posterior inferior cerebellar artery in 16 patients and vertebrobasilar artery in 2 patients; the responsible vessels were identified as anterior inferior cerebellar artery during operation in 33 patients, posterior inferior cerebellar artery in 16 patients, anterior inferior cerebellar artery and posterior inferior cerebellar artery in 1 patient and vertebrobasilar artery in 2 patients; the accuracy of preoperative judgment of responsible vessels was 98.0%(51/52).There was no significant difference in the accuracy of preoperative judgment of responsible vessels between the two groups(χ~2=6.914,P>0.05).The effective rate of patients in the control group was 92.59%(50/54),and the effective rate of patients in the observation group was 94.23%(49/52);there was no significant difference in the effective rate of patients between the two groups(χ~2=0.115,P>0.05).There were 38 patients whose lateral spread responses(LSR)-1 and LSR-2 disappeared during operation and they were cured after operation in the control group; there was 40 patients whose LSR-1 and LSR-2 disappeared during operation and they were cured after operation in the operation group.In the control group, among the 12 patients whose LSR-1 or LSR-2 completely disappeared and the amplitude of another LSR decreased by more than 50%,2 cases were cured and 10 cases were significantly relieved; in the observation group, among the the 9 patients whose LSR-1 or LSR-2 completely disappeared and the amplitude of another LSR decreased by more than 50%,3 cases were cured and 6 cases were significantly relieved.In the control group, among the 4 patients whose LSR-1 and LSR-2 did not disappear during operation, 3 cases were partial remission and 1 case was no remission; in the observation group, among the 3 patients whose LSR-1 and LSR-2 did not disappear during operation, 2 cases were partial remission and 1 case was no remission.The incidence of postoperative complications of patients in the control group was 9.25%(5/54),and the incidence of postoperative complications of patients in the observation group was 3.84%(2/52);there was no significant difference in the incidence of postoperative complications of patients between the two groups(χ~2=1.259,P>0.05).Conclusion The efficacy and safety of microscopic and endoscopic microvascular decompression under neurophysiological monitoring in the treatment of hemifacial spasm are all good, and there is no significant difference in the efficacy and safety between the two surgical methods.Neuroelectrophysiological monitoring of LSR-1 and LSR-2 can guide the correct judgment of responsible vessels and timely termination of surgery, and provide objective judgment basis for the curative effect of surgery.更多还原