반쪽얼굴연축에 대한 미세혈관감압술에서의 수술 중 신경계 감시

Abstract

Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective and curative treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (IONM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through IONM of brainstem auditory evoked potentials and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Through IONM mentioned above, MVD can be developed as a more safe and effective treatment for HFS.