摘要目的 探讨面肌痉挛患者面部注射肉毒素治疗后,对显微血管减压术中神经电生理监测指标侧方扩散(LSR)的影响.方法 回顾性研究广东省第二人民医院神经外科2013年7月至2014年12月,行显微血管减压术的面肌痉挛患者90例.根据手术前有无注射过肉毒素分为肉毒素组(18例)和非肉毒素组(72例).观察肉毒素对术中LSR变化的影响及LSR变化对预后评估的作用.结果 肉毒素组颧支LSR潜伏期平均为(11.4 ±2.1)ms,非肉毒素组为(9.3±1.4)ms,差异有统计学意义(P＜0.05).肉毒素组下颌支LSR潜伏期为(8.9±1.7)ms,非肉毒素组为(8.2±1.4)ms(P＞0.05).肉毒素组颧支LSR波幅为(116.1 ±61.1)μV,下颌支为(116.1±54.5)μV;非肉毒素组颧支为(125.5 ±55.8) μV,下颌支为(125.9± 52.1) μV,两组差异均无统计学意义(P＞0.05).置入垫片后,肉毒素组颧支、下颌支LSR消失比例分别为16/18、17/18;非肉毒素组颧支消失率为90％(65/72),下颌支为96％(69/72),两组差异均无统计学意义(P＞0.05).肉毒素组颧支LSR消失对预后判断的灵敏度为94％(15/16),非肉毒素组为98％(64/65),差异有统计学意义(P＜0.05).肉毒素组下颌支LSR及颧支和下颌支两支LSR同时消失对预后判断的灵敏度分别为94％(16/17)、94％(15/16);非肉毒素组的分别为93％(64/69)、97％ (59/61),两组差异均无统计学意义(P＞0.05).结论 肉毒素对术中LSR有影响,表现为颧支LSR潜伏期延长;下颌支或联合颧支LSR监测的方式,优于单纯监测颧支LSR.

abstractsObjective To investigate the effects of facial injecting botulinum toxin on electrophysiological monitoring indicator lateral spread response (LSR) in patients with hemifacial spasm in microvascular decompression surgery.Methods Ninety patients with facial spasm underwent microvascular decompression surgery in Guangdong No 2 Provincial People' s Hospital from July 2013 to December 2014 were enrolled retrospectively.They were divided into either a botulinum toxin group (n =18) or a non-botulinum toxin group (n =72) according to whether they injected botulinum toxin or not.The effect of botulinum toxin on the changes of intraoperative LSR and the role of LSR changes in prognostic evaluation were observed.Results The mean LSR latency of the zygomatic branch in the botulinum toxin group was 11.4 ± 2.1 ms,and in the non-botulinum toxin group was 9.3 ± 1.4 ms.There was significant difference (P ＜ 0.05).The LSR latency of the mandibular branch in the botulinum toxin group was 8.9 ± 1.7 ms,and in the non-botulinum toxin group was 8.2 ± 1.4 ms (P ＞ 0.05).The LSR amplitude of the zygomatic branch in botulinum toxin group was 116.1 ±61.1 μV,and in mandibular branch was 116.1 ± 54.5 μV;the zygomatic branch was 125.9 ± 52.1 μV,and the mandibular branch was 125.9 ± 52.1 μV in the non-botulinum toxin group.There was no significant difference between the 2 groups.After implantation of shims,the LSR disappear rates of zygomatic branchs,and mandibular branch were 16/18and 17/18 respectively in the botulinum toxin group;the zygomatic branch disappear rate in the non-botulinum toxin group was 90％ (65/72) and that in the mandibular branch was 96％ (69/72).There was no significant difference between the 2 groups (P ＞ 0.05).The sensitivity of the disappearance of zygomatic branch LSR for prognostic judgment in the botulinum toxin group was 94％ (15/16),and in the non-botulinum toxin group was 98％ (64/65).There was significant difference (P ＜ 0.05).The mandibular branch LSR,and the sensitivities of both zygomatic branch and mandibular branch disappeared simultaneously for prognostic judgment in the botulinum toxin group were 94％ (16/17) and 94％ (15/16) respectively;and in the non-botulinum toxin group were 92％ (64/69) and 96％ (59/61) respectively.There was no significant difference between the 2 groups.Conclusions Botulinum toxin has influence on intraoperative LSR.It is expressed as the prolonged LSR latency of zygomatic branch.The way of monitoring with mandibular branch or in combination with zygomatic branch LSR may be better than simply monitoring zygomatic branch LSR.