显微血管减压手术治疗椎动脉相关性面肌痉挛

Microvascular Decompression for Vertebral Artery Associated Hemifacial Spasm

目的总结椎动脉相关性面肌痉挛的显微血管减压手术经验。方法2008年10月~2019年10月,对78例椎动脉相关责任血管的面肌痉挛行显微血管减压术。术前均行MRI 3D-SPACE序列及MRA检查,提示手术区见粗大的血管影,术中证实均为椎动脉相关性责任血管。结果术中探查明确责任血管为椎动脉7例,椎动脉合并小脑前下动脉39例,椎动脉合并小脑后下动脉23例,椎动脉合并小脑前下动脉及小脑后下动脉9例。术后症状均消失,其中术后立即消失72例,1~6个月消失6例。术后术侧听力下降2例,均在术后6个月内恢复;面瘫1例,术后3个月恢复;张口、吞咽受限1例,1周恢复。无出血、感染、死亡。随访1年,症状均消失,无复发,无并发症。结论面肌痉挛患者术前行MRI 3D-SPACE及MRA检查有助于术前判断责任血管类型,并给术者探查责任血管提供心理准备。充分探查、逐步减压和适度的垫棉植入是保证手术效果、减少并发症的关键。

Objective To summarize the experience of microvascular decompression for vertebral artery associated hemifacial spasm.Methods From October 2008 to October 2019,microscopic vascular decompression was performed in 78 patients with hemifacial spasm related to the responsible vessels of vertebral artery.Preoperative MRI 3D-SPACE sequence and MRA were performed in all the patients,suggesting that thick vascular shadow was seen in the surgical area,which was proved to be vertebral artery associated offending vessels during the operation.Results In the intraoperative exploration,the identified responsible vessels were vertebral artery in 7 cases,vertebral artery combined with anterior inferior cerebellar artery in 39 cases,vertebral artery combined with posterior inferior cerebellar artery in 23 cases,and vertebral artery combined with anterior inferior cerebellar artery and posterior inferior cerebellar artery in 9 cases.The symptoms disappeared in all the patients,among which 72 cases disappeared immediately after surgery and 6 cases disappeared within 1-6 months.There were 2 cases of hearing loss on operative side after operation,and all recovered within 6 months after operation.One case of facial paralysis recovered 3 months after operation.Limitation of mouth opening and swallowing occurred in 1 case and recovered in 1 week.No bleeding,infection,or death was noted.All the patients were followed up for 1 year.Their symptoms disappeared,with no recurrence or complications.Conclusions Preoperative MRI 3D-SPACE sequence and MRA for patients with hemifacial spasm can help determine the type of responsible vessels preoperatively,and provide psychological preparation for surgeons to explore the responsible vessels.Comprehensive exploration,step-by-step decompression and moderate cotton pad implantation are the keys to ensure the operative effect and reduce complications.