面肌痉挛的微血管减压治疗

Microvascular decompression for hemifacial spasm

目的探讨微血管减压术治疗面肌痉挛的治疗策略,包括术前诊断评估,手术治疗技巧,并发症防治及疗效等。方法回顾分析52例行微血管减压术治疗原发性面肌痉挛患者的临床资料,所有患者术前有典型面肌痉挛表现,经MRI及MRA检查排除颅内占位性病变及确认责任血管的存在及其与面神经关系。行枕下乙状窦后入路微血管减压术。结果 50例病人术后症状即消失;2例病人术后症状减轻,其中1例半月后消失,另一例3月后消失。术后并发症轻度面瘫3例,耳鸣、听力下降6例,头晕、头痛、呕吐10例,经治疗后恢复,无脑脊液漏、颅内感染、颅内出血等严重并发症,无手术死亡病例。随访期间,1例患者半年后症状复发。结论微血管减压术是治疗原发性面肌痉挛的安全、疗效确切的方式。准确判断责任血管并精细的分离保护神经是关键。

Objective To explore the strategy of microvascular decompression （MVD） for hemifacial spasm （HFS）, including diagnosis, surgical technique, treatment and preventin for complications. Methods The clinical data of 52 patients with HFS who underwent MVD were analyzed retrospectively. MRI and MRA examinations were taken to exclude secondary cause of disease before operation, investigate whether the offending vessel was existed and their origin and running course. The offending vessels were carefully discriminated and separated from root exit zone （REZ） of the facial nerve. Results Rightly after surgery, symptoms of 50 patients completely relieved. 2 patients were significantly improved, and were also totally relieved in half of a month or 3 months after the surgery. Major complications included facial palsy, dizziness, hearing loss, headache and vomid. They recovered uneventfully after treatment. There was no CSF leakage, infection and mortality during the period of perioperation. Conclusions MVD is a safe and effective way for HFS. The correct discrimination of the offending vessels, accurate dissection and preservation of the nerve are the key points.