面神经血管减压术中责任血管辨认及处理技巧

Recognition and Management of Offending Vessels in the treatment of Hemifacial Spasm with Microvascular Decompression

目的探讨面神经血管减压术中探查确认责任血管的方法及其重要性,责任血管的处理技巧及疗效。方法回顾性分析71例显微血管减压术治疗面肌痉挛的临床资料。术前所有患者均行MRTOF及CISS序列检查,排除继发性因素并确定责任血管与面神经关系;术中根据MRI结果指导探查并判断责任血管;用Teflon棉片垫于面神经根部与脑干之间,面神经充分减压。结果术后55例患者症状立即消失,12例患者延迟缓解,4例无效,手术总的有效率为94.4%,无严重并发症。平均随访39个月,复发率为4.2%。结论显微血管减压术是目前面肌痉挛有效的首选治疗方法,术前MR的检查和术中责任血管的判断及处理技巧是影响手术疗效、减少并发症的重要因素。

Objective To investigate the importance of recognition of offending vessels,and the relationship between the curative effect and the management of offending vessels in the treatment of hemifacial spasm with microvascular decompression. Methods The clinical data of 71 patients with HFS treated with MVD were analyzed retrospectively.All patients underwent MR TOF and CISS sequence before the operation in order to find out the relationship between the offending vessels and facial never,and to exclude space occupying lesion. According to these,we selected the surgical planning.In operation,Teflon mattress were put between the facial never and the brainstem, to make the facial nerver were adequate decompression. Results The spasm resolved completely immediately after the operation in 55 patients,and the symptoms of spasm resolved were delayed in 12 patients,and there were 4 ineffctive patients.The total effective rate Was 94.4%.there were none severe complications. The average follow-up was 39 months, and the recurernce rate was 4.2%.Conclusion MVD is the first choice of teatment of HFS.Pre-opertion MRI, recognition and management of offending vessels in MVD are important factors of improving effective and reducing complications curative effect.