微血管减压术治疗面肌痉挛

Microvascular decompression surgery for hemifacial spasm

目的探讨微血管减压术治疗面肌痉挛的手术疗效、并发症发生率及手术策略。方法回顾分析46例面肌痉挛患者微血管减压术疗效。结果手术中可见动脉血管压迫面神经根部出脑干区,其中小脑前下动脉压迫24例(52.17%),小脑后下动脉压迫14例(30.43%),椎动脉和小动脉同时受压7例(15.22%),椎动脉压迫1例(2.18%)。38例手术后面肌抽搐症状完全缓解,8例症状显著减轻。主要并发症包括眩晕、耳鸣(9例),听力下降或丧失(5例),脑脊液漏(1例),感染(2例)。无一例手术中死亡。结论微血管减压术是治疗特发性面肌痉挛的首选方法,娴熟的显微外科手术技术及手术中正确识别责任血管并充分减压,是保证微血管减压术成功的关键。

Objective To investigate operative efficacy, surgical complication rate and surgical strategy of microvascular decompression （MVD） for hcmifacial spasm （HFS）. Methods The clinical data of 46 patients with HFS were retrospectively analysed. All patients underwent MVD. Results During operation, it was found that the facial nerve root exit zone （RExZ） was compressed by arterial vessels, namely anterior inferior cerebellar artery （AICA） in 24 cases （52.17%）, posterior inferior cerebellar artery （PICA） in 14 eases （30.43%）, vertebral artery and small artery in 7 cases （15.22%）, and vertebral artery in one ease （2.18%）. Symptoms in 38 patients were completely remitted immediately after surgery, and symptoms of 8 eases were reduced significantly. The main complications included dizziness and tinnitus in 9 eases, hearing loss in 5 cases, eerebrospinal fluid leakage in one case, and infection in 2 eases. No patient died during operation. Conclusion Microvascular decompression is the first choice for treating idiopathic hemifaeial spasm. Skilled microsurgical techniques, and identification and complete decompression of the responsible artery are the key to ensure success in microvascular decompression.