颅内面神经根梳刮术治疗面肌痉挛

Facial nerve root combing scraping for hemifacial spasm

目的：探讨治疗面肌痉挛疗效确切、安全可靠的面神经根显微术式。方法：采用颅内面神经根梳刮术治疗面肌痉挛患者25例。术中见明显血管压迫且易于分离者行血管移位隔垫，同时对面神经根进行适当梳理、刮剥以减少复发；未发现明显责任血管或遇穿通动脉、面神经根被动脉包绕不易移位隔垫血管者，行面神经根梳刮并剪断一小束神经纤维（1／6～1／5）。结果：术后面肌抽搐消失22例（88％），症状明显减轻2例（8％），无效1例（4％）。无术后感音神经性聋、颅内出血等严重并发症发生。25例患者术后均出现不同程度面瘫。随访2～8年，面瘫均在1～6个月内恢复，面部肌力基本恢复正常。2年内复发2例（8％）。结论：颅内面神经根梳刮术是治疗面肌痉挛有效的综合显微手术，其并发症少、适应证广且操作简便安全，术中根据不同情况采取相应处理可提高疗效、降低手术风险。

Objective：To explore the effective intracranial surgical method for hemifacial spasm which can be operated more safely and easily. Method：Twenty-five cases of hemifacial spasm underwent intracranial facial nerve root combing scraping by improved retrosigmoid approach. The compressing vessels were found in 10 cases and could be removed easily. Both microvascular decompression and facial nerve root combing scraping were performed to reduce recurrence. The other cases with perforating artery or without any compressing vessels underwent the facial nerve root combing scraping and cutting off partially for about 1/6 - 1/5 neural fibers. Result： Hemifacial spasms were obliterated in 22 cases （88%） after operation, obviously relieved in 2 cases （8%）, invalid in 1 case （4%）. Varied facial nerve paralysis was observed in 25 patients, but no hearing disturbance and other serious complication occurred. Follow-up for 2- 8 years showed there were recurrences in 2 cases（8%） and the facial nerve paralysis of 25 cases recovered in 1 -6 months after operation. Conclusion： The facial nerve root combing scraping is an effective and safe microsurgical procedure which has wide-ranged indication and less complication. It is very important to select suitable treatment for the patient individually during the operation to improve the efficacy and lower the risk.