神经内镜下乙状窦后锁孔入路微血管减压术治疗面肌痉挛

Neuroendoscopic microvascular decompression for hemifacial spasm through retrosigmoid key hole approach

目的探讨神经内镜下乙状窦后锁孔入路微血管减压术治疗面肌痉挛的手术技巧。方法根据患者的临床症状及药物控制情况筛选出31例面肌痉挛患者,对以上患者全部行神经内镜下乙状窦后锁孔入路微血管减压术。结果 31例患者中,面肌痉挛症状完全缓解者24例(27.4%),明显减轻者6例(19.4%),未缓解1例(3.2%),术后出现轻度面瘫3例(9.68%),听力下降2例(6.45%),头晕伴频繁恶心呕吐者1例(3.23%),术后发热2例(6.45%)。无术后出血及小脑挫伤病例,无脑脊液漏及刀口愈合不良病例。结论神经内镜下乙状窦后锁孔入路微血管减压术治疗面肌痉挛是在充分掌握神经解剖及熟练应用神经内镜基础上,取得高效微创治疗效果的一种新手术方式。

Objective To explore the surgical techniques of neuroendoscopic microvascular decompression for hemifacial spasm through retrosigmoid key hole approach. Methods A total of 31 patients with hemifacial spasm were selected based on clinical symptoms and conditions after drug use. Then neuroendoscopic microvascular decompression through retrosigmoid key hole approach was performed. Results After surgery,pain disappeared in 24（ 77. 4%） and reduced in 6 patients（ 19. 4%）,while 1 patient（ 3. 2%） showed no obvious amelioration. Postoperative complications included mild facial parelysis in 3 cases（ 9. 68%）,hearing loss in 2 cases（ 6. 45%）,headache with frequent nausea and vomiting in 1 case（ 3. 23%）,and fever in 2 cases（ 6. 45%）. No postoperative bleeding,cerebellum contusion,leakage of cerebrospinal fluid or blade poor healing were observed. Conclusion Neuroendoscopic microvascular decompression through retrosigmoid key hole approach is a novel,effective and minimally invasive way to treat hemifacial spasm.