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Predictive Value of Intraoperative Facial Nerve Response Thresholds on the Recovery Effect After Facial Nerve Decompression
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摘要:
目的 探究贝尔面瘫患者术中面神经直接刺激阈值与术后面神经功能恢复的关系。 方法 回顾性收集2015年10月—2022年10月于北京天坛医院行面神经减压术的贝尔面瘫患者的临床资料，选取术中采用面神经监测并准确记录面神经直接刺激阈值以及至少有术后1年详细随访记录的患者进行统计分析，将术后面神经功能恢复至Ⅰ~Ⅱ级(HB分级)定义为术后恢复良好，恢复至Ⅲ级及以上定义为恢复不良，并按面神经反应兴奋性将患者分为A、B两组，A组直接刺激阈值≤1.5 mA，B组直接刺激阈值＞1.5 mA或刺激量增加至3 mA仍未记录到神经反应波形，分析术后面神经功能恢复情况与面神经直接刺激阈值的关系。 结果 共36例符合纳入与排除标准的贝尔面瘫患者入选本研究，均在发病1~3个月内接受经乳突-上鼓室入路面神经减压术，术后面神经功能恢复良好组24例(66.7%)，恢复不良组12例(33.3%)。仅20例(55.6%，20/36)患者术中记录到面神经直接刺激阈值，且均≤1.5 mA(0.1~1.5 mA)，16例(44.4%，16/36)即使在面神经刺激量增加至3 mA也未能记录到面神经反应波形。术后面神经功能恢复良好组与恢复不良组在年龄、性别、面瘫侧别、手术时机、术前面神经电图等方面差异均无统计学意义(P均＞0.05)，但A组患者术后面神经功能恢复良好率明显高于B组(P=0.009)。 结论 对于行面神经减压术的贝尔面瘫患者，术中面神经直接刺激阈值可能对术后面神经功能恢复具有一定预判价值。 Abstract:Objective To investigate the relationship between the thresholds of intraoperative facial nerve response and postoperative facial nerve function recovery in patients with Bell's palsy. Methods Clinical data from Bell's palsy patients who underwent facial nerve decompression surgery at Beijing Tiantan Hospital from October 2015 to October 2022 were collected. The patients selected for analysis had intraoperative facial nerve monitoring with accurate recording of the facial nerve direct stimulation threshold and at least 1 year of detailed follow-up. The patients with postoperative facial nerve function recovery to grade Ⅰ-Ⅱ (HB grading) were defined as having good recovery, while those recovering to grade Ⅲ or higher were defined as having poor recovery. The patients were divided into two groups (A and B) according to facial nerve reaction excitability, with group A having a direct stimulation threshold of ≤1.5 mA and group B having a direct stimulation threshold of > 1.5 mA or a stimulation volume up to 3 mA without being able to record neural response waveform. The relationship between postoperative facial nerve function recovery and facial nerve direct stimulation threshold was analyzed. Results A total of 36 Bell's palsy patients were included in this study, who underwent facial nerve decompression surgery through the transmastoid-epitympanum approach within 1-3 months after onset. Of the 36 patients, 24 (66.7%) had good recovery and 12 (33.3%) had poor recovery. Only 20 (55.6%, 20/36) patients had facial nerve direct stimulation threshold recorded during the operation, and all were ≤1.5 mA(0.1-1.5 mA). The reaction waveforms of 16 (44.4%, 16/36) patients could not be recorded even when facial nerve stimulation increased to 3 mA. There was no significant difference in age, gender, lateral discourse, timing of surgery, and preoperative electroneurography (ENoG) between the two groups(all P > 0.05), but the good recovery rate of the patients in group A was significantly higher than that in group B, and the difference was statistically significant (P=0.009). Conclusion For patients with Bell's palsy undergoing decompression surgery of the facial nerve, the intraoperative direct stimulation threshold of the facial nerve may have some predictive value for postoperative facial nerve function recovery. 作者贡献：王璞完成数据收集、分析，撰写论文初稿；张文阳参与实验设计和结果分析；夏寅和王咏峰为项目总负责人，指导研究设计、数据分析、论文写作及修改。利益冲突：所有作者均声明不存在利益冲突 -
图 1 经乳突面神经次全程减压术
1.乙状窦；2.外耳道后壁；3.水平半规管；4.后半规管；5.二腹肌嵴；6.镫骨；7.茎乳孔；8.面神经垂直段；9.面神经锥曲段；10.面神经水平段；→指示电极刺激面神经膝状神经节
表 1 两组患者一般临床资料比较
指标 术后面神经功能恢复情况 P值 恢复良好组(n=24) 恢复不良组(n=12) 年龄(x±s，岁) 44.17±15.32 48.58±14.73 0.415 性别[n(%)] 0.471 男 16(66.7) 6(50.0) 女 8(33.3) 6(50.0) 面瘫侧别[n(%)] 1.000 左侧 13(54.2) 7(58.3) 右侧 11(45.8) 5(41.7) ENoG (Oculi)(x±s，%) 0.933±0.031 0.936±0.029 0.410 ENoG (Oris)(x±s，%) 0.940±0.029 0.928±0.032 0.130 随访时间(x±s，月) 16.17±4.10 16.58±3.99 0.390 手术时机[n(%)] 0.637 1~2个月 12(50.0) 7(58.3) 2~3个月 12(50.0) 5(41.7) ENoG: 面神经电图 
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表 2 不同术中面神经直接刺激阈值患者术后面神经功能恢复情况[n(%)]
组别 术后面神经功能恢复情况 恢复良好组(n=24) 恢复不良组(n=12) A组(n=20) 17(85.0) 3(15.0) B组(n=16) 7(43.8) 9(56.2) P值 0.009
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