作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Predictive Value of Intraoperative Facial Nerve Response Thresholds on the Recovery Effect After Facial Nerve Decompression
-
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手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术后至少有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≤1.5mA，B组直接刺激阈值>1.5mA或刺激量增加至3mA仍未记录到神经反应波形，比较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例符合纳入和排除标准的贝尔面瘫患者纳入本研究，均在发病1～3个月内接受经乳突-上鼓室入路面神经减压手术，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%），仅有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 对于行面神经减压手术的贝尔面瘫患者，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. Patients who had intraoperative facial nerve monitoring with accurate recording of the facial nerve direct stimulation threshold and had at least 1 year of detailed follow-up were selected for analysis. Patients with postoperative facial nerve function recovery to grade I-II (HB grading) were defined as having good recovery, while those who recovered to grade III or higher were defined as having poor recovery. 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 an increase in stimulation volume to 3mA, but no neural response waveform was recorded. The relationship between postoperative facial nerve function recovery and facial nerve direct stimulation threshold was compared. Results A total of 36 Bell’s palsy patients were included in this study and 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 ≤1.5mA (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 3mA. There was no significant difference in age, gender, lateral discourse, timing of surgery , and preoperative electroneurography (ENoG) in group A and group B, but the good recovery rate of 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.
-
[1] Singh A, Deshmukh P. Bell's Palsy: A Review[J]. Cureus, 2022,14:e30186. [2] Kline LB, Kates MM, Tavakoli M. Bell Palsy[J]. JAMA, 2021,326:1983. [3] Vakharia K, Vakharia K. Bell's Palsy[J]. Facial Plast Surg Clin North Am, 2016,24:1-10. [4] Zhang W, Xu L, Luo T, et al. The etiology of Bell's palsy: a review[J]. J Neurol, 2020,267:1896-1905. [5] Baugh RF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy[J]. Otolaryngol Head Neck Surg, 2013,149:S1-S27. [6] Lee SY, Seong J, Kim YH. Clinical Implication of Facial Nerve Decompression in Complete Bell's Palsy: A Systematic Review and Meta-Analysis[J]. Clin Exp Otorhinolaryngol, 2019,12:348-359. [7] Casano K, Giangrosso G, Mankekar G, et al. Additional Benefits of Facial Nerve Monitoring during Otologic Surgery[J]. Otolaryngol Head Neck Surg, 2020,163:572-576. [8] 胡凌翔, 吴皓, 杨军,等. 听神经瘤患者术中面神经刺激阈与术后早期面神经功能的关系[J]. 听力学及言语疾病杂志,2010,18:531-533. [9] House JW, Brackmann DE. Facial nerve grading system[J]. Otolaryngol Head Neck Surg, 1985,93:146-147. [10] 陈兵. 术中面神经定位及医源性面瘫的预防[J]. 中国眼耳鼻喉科杂志,2009,9:276-278. [11] Quimby AE, Lui J, Chen J. Predictive Ability of Direct Electrical Stimulation on Facial Nerve Function Following Vestibular Schwannoma Surgery: A Systematic Review and Meta-analysis[J]. Otol Neurotol, 2021,42:493-504. [12] Bernat I, Grayeli AB, Esquia G, et al. Intraoperative electromyography and surgical observations as predictive factors of facial nerve outcome in vestibular schwannoma surgery[J]. Otol Neurotol, 2010,31:306-312. [13] Sprenghers L, Lemmens R, van Loon J. Usefulness of intraoperative monitoring in microvascular decompression for hemifacial spasm: a systematic review and meta-analysis[J]. Br J Neurosurg, 2022,36:346-357. [14] Zhong W, Ying T, Li S, et al. New Technology: Compound Abnormal Muscle Response During Microvascular Decompression for Hemifacial Spasm[J]. J Craniofac Surg, 2022,33:e283-e285. [15] Yamagishi T, Ohshima S, Yagi C, et al. Nerve Integrity Monitor Responses to Direct Facial Nerve Stimulation During Facial Nerve Decompression Surgery Can Predict Postoperative Outcomes[J]. Otol Neurotol, 2020,41:704-708. [16] Berania I, Awad M, Saliba I, et al. Delayed facial nerve decompression for severe refractory cases of Bell's palsy: a 25-year experience[J]. J Otolaryngol Head Neck Surg, 2018,47:1. [17] 吴海燕, 姜鸿, 冯国栋,等. 经乳突面神经减压术治疗贝尔氏面瘫[J]. 中华耳科学杂志,2014:380-385. [18] Kwon KJ, Bang JH, Kim SH, et al. Prognosis prediction changes based on the timing of electroneurography after facial paralysis[J]. Acta Otolaryngol, 2022,142:213-219. [19] Takemoto N, Horii A, Sakata Y, et al. Prognostic factors of peripheral facial palsy: multivariate analysis followed by receiver operating characteristic and Kaplan-Meier analyses[J]. Otol Neurotol, 2011,32:1031-1036. -
点击查看大图
计量
- 文章访问数: 21
- HTML全文浏览量: 3
- PDF下载量: 2
- 被引次数: 0
下载:
