悬吊责任动脉技术治疗面肌痉挛的临床分析

Clinical analysis of the offending vessel suspension technique in microvascular decompression for hemifacial spasm

目的分析采用悬吊责任动脉技术行显微血管减压术(MVD)治疗面肌痉挛的临床疗效。方法回顾性分析南京鼓楼医院神经外科自2018年1月至7月采用悬吊责任动脉技术行MVD治疗的82例面肌痉挛患者的临床资料,分析其手术效果及并发症的发生情况。结果本组患者术中责任血管为椎动脉联合分支血管压迫19例(椎动脉合并小脑前下动脉15例,椎动脉合并小脑后下动脉3例,椎动脉合并小脑前下动脉、后下动脉1例),非椎动脉的多支血管压迫13例(小脑前下动脉多分支4例,小脑前下动脉联合小脑后下动脉9例),动脉袢冗长、压迫路径长20例(小脑前下动脉),减压支点正好在REZ区或有短小穿支血管30例(小脑前下动脉28例,小脑后下动脉2例),采用悬吊责任动脉法后均彻底减压。术后即刻治愈率为96.3%(79/82),有效率为98.8%(81/82)。随访28~34个月,患者治愈率87.8%(72/82),有效率97.6%(80/82),3例面瘫,3例听力下降。结论悬吊责任动脉技术可作为面肌痉挛MVD的一种补充技术,尤其适用于单纯利用垫棉无法充分减压的情况,具有操作简单、安全、可逆的特点,但应注意建立可靠、稳定的神经血管位置关系,保持移位血管血流通畅,避免复发,降低并发症发生率。

Objective To analyze the clinical effect of the offending vessel suspension technique in microvascular decompression(MVD)in the treatment of facial spasm.Methods The clinical data of 82 patients with facial spasm treated by MVD with the offending vessel suspension technique in the Neurosurgery Department of Nanjing Drum Tower Hospital from January to July 2018 were analyzed retrospectively,and the surgical effect and postoperative complications were recorded and analyzed.Results The large heavy compressed conflicting vessel was found in 19 cases:15 cases of vertebral artery associated with anterior inferior cerebellar artery(AICA),3 cases with posterior inferior cerebellar artery(PICA),1 case with AICA and PICA.The multiple vessels were found in 13 cases:9 cases of AICA associated with PICA,4 cases of the branches of AICA.An elongated loop was found in 20 cases.No decompression fulcrum or perforator with brainstem in 30 cases:28 cases of AICA,2 cases of PICA.Using the hanging technique,the permanent and complete transposition of the offending vessel was achieved.The immediate postoperative care rate was 96.3%(79/82)and the effective rate was 98.8%(81/82).The patients were followed up for 28 to 34 months,the care rate was 87.8%(72/82),and the effective rate was 97.6%(80/82),3 cases of transient facial palsy and 3 cases of hearing loss.Conclusion The offending vessel suspension technique can be used as supplementary technique for traditional MVD of facial spasm,especially when the cotton pad alone can not fully decompress.This method is easily applied,reversible and with little damage.It is essential for making stable neurovascular relationship,to avoid recurrence and the complications.