锁孔乙状窦后入路显微血管减压术治疗面肌痉挛(附43报告)

Treatment of hemifacial spasm with microvascular decompression through retrosigmoid key hole approach:a report of 43 cases

目的探讨锁孔乙状窦后入路显微血管减压术(MVD)治疗面肌痉挛的手术方法、效果及并发症。方法对2008年9月-2009年5月收治的43例面肌痉挛患者行MVD,其中男13例,女30例,年龄32～65岁,平均47岁,病程6个月～9年。发病均为单侧,左侧24例,右侧19例。所有患者均采用乳突后发际内小切口,小骨窗开颅,显微镜下探查桥小脑角,寻找并判断责任血管,在面神经根部出脑干区(REZ)分离责任血管,植入Teflon垫棉分隔并减压。观察术后效果和并发症,电话随访1～6个月。结果术中均发现明确的责任血管压迫REZ。43例中,39例术后症状立即消失,3例症状明显减轻,1例无效。2例术后听力明显下降,其中1例1周后恢复,1例未恢复。随访1～6个月无面肌痉挛复发。结论锁孔乙状窦后入路MVD治疗面肌痉挛安全、有效。正确的手术方法是提高手术效果及减少并发症的重要因素。

Objective To explore the surgical method,effect and postoperative complications in the treatment of hemifacial spasm with microvascular decompression through retrosigmoid key hole approach.Methods Microvascular decompression was performed in 43 cases of hemifacial spasm（13 males and 30 females,aged 32 to 65 with a mean of 47 years,hemifacial spasm occurred on left side in 24 cases and on right side 19 cases,course ranged from 6 months to 9 years）from Sep.2008 to May 2009.Retrosigmoid key hole approach was used.A small incision behind mastoid and upper hairline,and keyhole craniotomy were made in all the patients,the cerebellopontine was explored,and then the offending vessels were identified and separated from the root exit zone of facial nerve.A teflon graft was interposed between the offending vessels and root exit zone of brain stem.The therapeutic effect and complications were recorded,and all the patients were followed-up for 1 to 6 months.Results Definite offending vessels were found to oppress the root exit zone of facial nerve in all the patients.After the operation,the symptoms disappeared in 39 cases,ameliorated in 3 cases,and no obvious effect in 1 case.Hearing loss was found in 2 cases,one of them recovered 1 week after operation,and the other failed to recover.No recurrence was found in 42 patients with total relief during the follow-up period.Conclusion Microvascular decompression through retrosigmoid key hole approach is an effective and reliable treatment method for hemifacial spasm.The proper surgical method is beneficial in to improving the operative results with less complications.