Neurological Surgery 脳神経外科34巻6号

2006年06月発行

研究

片側顔面痙攣に対する神経減圧術中の顔面異常筋電図モニタリング所見と長期予後

著者： 福多真史¹ 山下慎也¹ 川口正¹ 渡部正俊¹ 村上博淳¹ 高尾哲郎¹ 田中隆一¹

所属機関： ¹新潟大学脳研究所脳神経外科

ページ範囲：P.583 - P.589

Ⅰ．は じ め に

　片側顔面痙攣に対する微小血管減圧術中の顔面異常筋電図（abnormal muscle response，以下AMR）は術後の症状消失を予測する術中モニタリングとして用いられているが，その有用性については賛否が分かれている^{2,3,6,7,10-12)}．特に減圧操作前の早期にAMRが消失したり，解剖学的に確実に減圧操作が完了したと判断された場合でもAMRが残存したりする症例があり，これらがモニタリングとしての有用性に疑問を投じる原因となっている．最近，われわれは60例のAMRモニタリング症例を検討し術後の予後を予測するうえでの有用性について報告した²⁰⁾．今回60例の症例中術後5年以上観察できた症例を分析し，術中AMRモニタリング所見，特に早期消失例および残存例と長期予後との関係について検討した．

参考文献

1）Fukuda M, Kameyama S, Honda Y, Tanaka R：Hemifacial spasm resulting from facial nerve compression near the internal acoustic meatus：case report. Neurol Med Chir (Tokyo) 37：771-774, 1997

2）Haines SJ, Torres F：Intraoperative monitoring of the facial nerve during decompressive surgery for hemifacial spasm. J Neurosurg 74：254-257, 1991

3）Hatem J, Sindou M, Vial C：Intraoperative monitoring of facial EMG responses during microvascular decompression for hemifacial spasm. Prognostic value for long-term outcome：a study in a 33-patient series. Br J Neurosurg 15：496-499, 2001

4）Ishikawa M, Ohira T, Namiki J, Ajimi Y, Takase M, Toya S：Abnormal muscle response (lateral spread) and F-wave in patients with hemifacial spasm. J Neurol Sci 137：109-116, 1996

5）Ishikawa M, Ohira T, Namiki J, Kobayashi M, Takase M, Kawase T, Toya S：Electrophysiological investigation of hemifacial spasm after microvascular decompression：F-waves of the facial muscles, blink reflexes, and abnormal muscle responses. J Neurosurg 86：654-661, 1997

6）Isu T, Kamada K, Mabuchi S, Kitaoka A, Ito T, Koiwa M, Abe H：Intra-operative monitoring by facial electromyographic responses during microvascular decompressive surgery for hemifacial spasm. Acta Neurochir (Wien) 138：19-23, 1996

7）Kiya N, Bannur U, Yamauchi A, Yoshida K, Kato Y, Kanno T：Monitoring of facial evoked EMG for hemifacial spasm：A critical analysis of its prognostic value. Acta Neurochir (Wien) 143：365-368, 2001

8）Mφller AR：Interaction between the blink reflex and the abnormal muscle response in patients with hemifacial spasm：Results of intraoperative recordings. J Neurol Sci 101：114-123, 1991

9）Mφller AR, Jannetta PJ：On the origin of synkinesis in hemifacial spasm：results of intracranial recordings. J Neurosurg 61：569-576, 1984

10）Mφller AR, Jannetta PJ：Microvascular decompression in hemifacial spasm：Intraoperative electrophysiological observations. Neurosurgery 16：612-618, 1985

11）Mφller AR, Jannetta PJ：Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm. J Neurosurg 66：681-685, 1987

12）Mooij JJ, Mustafa MK, van Weerden TW：Hemifacial spasm：intraoperative electromyographic monitoring as a guide for microvascular decompression. Neurosurgery 49：1365-1371, 2001

13）Murakami H, Kawaguchi T, Fukuda M, Ito Y, Hasegawa H, Tanaka R：Monitoring of the lateral spread response in the endovascular treatment of a hemifacial spasm caused by an unruptured vertebral artery aneurysm. Case report. J Neurosurg 101：861-863, 2004

14）Nielsen VK：Pathophysiology of hemifacial spasm：I. Ephaptic transmission and ectopic excitation. Neurology 34：418-426, 1984

15）Nielsen VK：Pathophysiology of hemifacial spasm：II. Lateral spread of the supraorbital nerve reflex. Neurology 34：427-431, 1984

16）Nielsen VK：Electrophysiology of the facial nerve in hemifacial spasm：Ectopic/ ephaptic excitation. Muscle Nerve 8：545-555, 1985

17）Shin JC, Chung UH, Kim YC, Park CI：Prospective study of microvascular decompression in hemifacial spasm. Neurosurgery 40：730-735, 1997

18）Wilkinson MF, Kaufmann AM：Monitoring of facial muscle motor evoked potentials during microvascular decompression for hemifacial spasm：evidence of changes in motor neuron excitability. J Neurosurg 103：64-69, 2005

19）Yamashita S, Kawaguchi T, Fukuda M, Suzuki K, Watanabe M, Tanaka R, Kameyama S：Lateral spread response elicited by double stimulation in patients with hemifacial spasm. Muscle Nerve 25：845-849, 2002

20）Yamashita S, Kawaguchi T, Fukuda M, Watanabe M, Tanaka R, Kameyama S：Abnormal muscle response monitoring during microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 147：933-938, 2005