神经内镜在面神经显微血管减压术中的应用

Clinical application of neuroendoscopy in microvascular decompression for hemifacial spasm

目的探讨单纯神经内镜显微血管减压术的可行性和技术要点。方法回顾性分析我科2008年12月至2010年12月收治的50例面肌痉挛患者，其中45例采取单纯内镜手术，5例采用内镜辅助显微手术。结果随访期间内镜49例临床症状完全缓解，1例减轻，无小脑梗死及水肿病例，无颅内感染及出血等严重并发症。内镜手术有2例止血困难而在显微镜下完成止血过程。结论神经内镜可以抵近观察，能够避免责任血管的遗漏，疗效确切。还具有对小脑牵拉小、术后并发症少的优点。单纯神经内镜手术能够完成显微血管减压术，该技术经过专业培训够熟练掌握，值得临床推广。

Objective To explore the feasibility and technical points of pure neuroendoscopic microvascular decompression for hemifacial spasm. Methods A retrospective analysis was conducted for 50 patients with hemifacial spasm enrolled in Beijing Sbijitan Hospital from Dee. 2008 to Dec. 2010. 5 patients were accepted microscopic microvacular decompression assisted by neuroendoscopy. The other 45 patients accepted pure neuroendoscopic microvacular decompression. Results 49 patients were cured for hemifacial spasm and only 1 patient was alleviated during the follow- up period. There was no cerebellar infarction or contusion. There was no severe complication such as hemorrhage or infection. 2 cases encountered intraoperative hemorrhage and the microscope had to be used for hemostasis. Conclusions The nerves and vasculars could be observed in a little distance under endoscope and missing the responsible arteries chould be avoided. As a minimal invasive and effective procedure, pure neuroendoscopic surgery could accomplish the microvacular decompression for facial nerve after professional training. It is worth in clinical application.