面神经根梳刮术治疗面肌痉挛并发症的预防

Prevention of complication in facial nerve root combing scraping for hemifacial spasm

目的探讨颅内面神经根梳刮术治疗面肌痉挛的疗效及其并发症的预防。方法采用改良乙状窦后进路颅内面神经根梳刮术治疗面肌痉挛患者29例。术中沿面神经根长轴纵向梳理面神经约7-10个层面,再将纤刀倾斜45°对神经纤维进行多层面刮剥,发现面神经根有明显血管压迫且较易分离者加以血管移位隔垫。结果术中发现小脑前下动脉压迫面神经根19例(65.5%),神经周围蛛网膜粘连者3例(10.3%),既无血管压迫又无珠网膜粘连7例(24.1%)。术后面肌抽搐消失25例(86.2%),症状减轻3例(10.3%),无效1例(3.4%),总有效率96.5%。无1例出现感音神经性聋及颅内出血等严重并发症,但患者术后均出现不同程度面瘫。随访18个月以上,面瘫均在6个月内恢复,面部肌力恢复达House-brackm annⅠ级或Ⅰ-Ⅱ级,复发2例(6.9%)。结论改良乙状窦后进路颅内面神经根梳刮术为治疗面肌痉挛的一种操作简便的有效颅内术式,在一定程度上能减少严重并发症的发生。

Objective To study the effective intracranial operation for hemifacial spasm and the prevention of complication. Method Intracranial facial nerve root combing scraping by improved retrosigmoid approach were carried out for 29 eases with hemifacial spasm. Facial nerves were combed longitudinally for about 7 - 10 layers and then scraped by fine knife inclining for 45 degrees. Mierovaseular decompression was performed at the same time for the cases in which the compressing vessels were obvious and could be removed easily. Result Among 29 eases ,facial nerve roots were compressed by anterior inferior eerebellar artery in 19 eases（ 65.5% ）, araehnoids adhesion occurred in 3eases（ 10.3% ） ,no arachnoids adhesion and artery compression in 7 eases（24.1% ）. Hemifaeial spasms were obliterated in 25 eases （ 86.2% ） after operation, relieved in 3 eases （ 10. 3% ）, invalid in 1 ease （ 3.4% ）. Varied facial nerve paralysis were observed in 29 patients, but no hearing disturbance and other serious complication occurred. Follow-up for more than 18 months showed 2 eases recurred （ 6.9% ） and all facial nerve paralysis got recovered in 6 months after operation and reach Housebraekmann grade Ⅰ or Ⅰ-Ⅱ. Conclusion Facial nerve root combing scraping by improved retrosigmoid approach is an effective intraeranial mierosurgieal method for hemifaeial spasm which can be operated more easily, and to some degrees we can decrease the occurrence of seriouscomplications by the procedure.