背景:前庭神经鞘瘤(VS)手术可能导致面神经损伤。然而,术后面部结局的综合评估可能难以实现.表面肌电图(sEMG)是一种有前途的非侵入性评估工具。然而,其在VS手术后的随访中的使用尚未报道。主要目标是开发和验证专门用于VS手术后设置的新sEMG应用程序。次要目标是提供VS手术后面部肌肉活动的系统描述,并评估sEMG参数与Sunnybrook量表评分之间的关联。
方法:纳入33例VS术后面神经麻痹患者。临床结果(Sunnybrook对称性,运动,和联合运动评分)和sEMG参数(通过最大自愿收缩(NEMG)和sEMG联合运动评分(ESS,每个运动序列的联合运动次数))在随访结束时进行评估。
结果:在所有测试的肌肉中,NEMG方差在患侧明显高于对侧(方差比检验,每块肌肉的p<0.00001)。总的来说,33例患者中有30例(90.9%)的ESS≥1(中位数:2.5,IQR:1.5-3.0)。在受影响的一方,NEMG值与动态和总体Sunnybrook得分呈正相关(Spearman模型,每个肌肉的p<0.05,除眼轮匝外)。ESS与Sunnybrook综合征评分显著相关(Spearman’srho:0.8268,p<0.0001)。
结论:我们描述并初步验证了一种新的多参数sEMG方法,该方法基于信号幅度和联合运动评估,特别适用于脑神经外科。必须进行大规模研究以进一步表征面部sEMG的符号学和预后价值。
BACKGROUND: Vestibular schwannoma (VS) surgery may cause facial nerve damage. However, a comprehensive evaluation of post-operative facial outcomes may be difficult to achieve. Surface electromyography (sEMG) is a promising non-invasive evaluation tool. However, its use in the follow-up after VS surgery has not been reported yet. The main objective was to develop and validate a new sEMG application specifically for the post-VS surgery setting. Secondary goals were to provide a systematic description of facial muscle activity after VS surgery and assess the association between sEMG parameters and Sunnybrook scale scores.
METHODS: Thirty-three patients with facial palsy following VS surgery were included. The clinical outcomes (Sunnybrook symmetry, movement, and
synkinesis scores) and sEMG parameters (signal amplitude normalized by the maximal voluntary contraction (NEMG) and sEMG
synkinesis score (ESS, number of
synkinesis per movement sequence)) were evaluated at the end of the follow-up.
RESULTS: In all tested muscles, NEMG variance was significantly higher on the affected side than the contralateral (variance ratio test, p < 0.00001 for each muscle). In total, 30 out of 33 patients (90.9%) showed an ESS ≥ 1 (median: 2.5, IQR: 1.5-3.0). On the affected side, NEMG values positively correlated with both dynamic and overall Sunnybrook scores (Spearman\'s model, p < 0.05 for each muscle, except orbicularis oculi). ESS significantly correlated with the Sunnybrook
synkinesis score (Spearman\'s rho: 0.8268, p < 0.0001).
CONCLUSIONS: We described and preliminarily validated a novel multiparametric sEMG approach based on both signal amplitude and
synkinesis evaluation specifically for oto-neurosurgery. Large-scale studies are mandatory to further characterize the semiological and prognostic value of facial sEMG.