椎-基底动脉迂曲对面神经MVD手术效果的影响

Influence of tortuous vertebrobasilar artery on surgical outcome of microvascular decompression for hemifacial spasm

目的探讨迂曲椎-基底动脉对面肌痉挛显微血管减压术(MVD)效果的影响。方法收集138例面肌痉挛病人,根据术前三维时间飞跃法磁共振血管造影(3D-TOF-MRA)检查是否合并迂曲的椎-基底动脉,分为迂曲组(n=57)和正常组(n=81)。两组均采用MVD治疗,术中行异常肌反应(AMR)监测。分析两组的病例特点、手术疗效以及影响因素。结果与正常组比较,迂曲组术后耳鸣、眩晕等并发症的发生率较高(P<0.05)。两组有效率差异无统计学意义(P>0.05),但迂曲组术后面肌痉挛的复发率高于正常组(P<0.01)。结论迂曲椎-基底动脉可能会增加MVD手术难度,增加并发症发生概率,术后相对易复发,详细探查并充分减压面神经根部出脑干区以及应用神经电生理监测有助于提高手术的成功率。

Objective To explore the influence of tortuous vertebrobasilar artery on microvascular decompression（MVD） for hemifacial spasm. Methods A sum of 138 hemifacial spasm patients were collected and divided into tortuous group（n = 57） and normal group（n =81） according to preoperative examination results by three dimensional time of flight magnetic resonance angiography（3 D-TOF-MRA）.All the patients were treated by MVD and monitored by abnormal muscle response（AMR）. The characteristics, surgical outcome and influential factors were analyzed and compared. Results Compared with the normal group, the rates of postoperative tinnitus and dizziness were higher in tortuous group（P 0.05）. There was no significant difference in effective rate between the two groups（P 0.05）. However the relapse rate of hemifacial spasm was higher in tortuous group than in normal group（P 0.01）. Conclusions The tortuous vertebrobasilar artery may increase the difficulty of the MVD and the rates of complications and recurrence. The detailed exploration, complete decompression of the facial nerve root exit zone（REZ） and electrophysiological monitoring are helpful for increasing successful rate of operation.