椎动脉相关型面肌痉挛显微血管减压术的疗效分析

Prognostic analysis of microvascular decompression for vertebral artery associated hemifacial spasm

目的 比较显微镜与神经内镜下椎动脉相关型面肌痉挛显微血管减压术的疗效。方法 回顾性收集2018年1月—2020年12月南京医科大学第一附属医院收治的54例行面神经显微血管减压术的椎动脉相关型面肌痉挛患者的临床资料,比较显微镜下和神经内镜下面神经显微血管减压术的并发症及疗效。结果 显微镜手术组30例患者中,治愈18例,延迟治愈11例,无效1例,手术有效率为96.67%,延迟治愈率36.67%,无效率3.33%,手术相关并发症发生率3.33%。神经内镜手术组24例患者中,治愈21例,延迟治愈3例,无效0例,手术有效率100%,延迟治愈率12.50%,无效率0,手术相关并发症发生率4.17%。2组患者治愈率的差异无统计学意义(P>0.05),但显微镜手术组延迟治愈率明显高于神经内镜手术组,差异有统计学意义(P<0.05)。2组患者术后并发症发生率的差异无统计学意义(P>0.05)。结论 神经内镜下显微血管减压术对于椎动脉相关型面肌痉挛患者是一种安全有效的手术方式,可在一定程度上降低患者的延迟治愈率。

Objective To compare the effectiveness of microscope-guided vs neuroendoscop-guided microvascular decompression in the facial nerve for vertebral artery associated hemifacial spasm.Methods A total of 54 patients who underwent microvascular decompression due to vertebral artery associated hemifacial spasm in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were enrolled and their clinical data were retrospectively analyzed.The postoperative complications and effectiveness of microscope-guided vs neuroendoscop-guided microvascular decompression in the facial nerve were compared.Results Among 30 patients in the microscope-guided surgery group,18 cases were cured,11 cases were delayed cured,and 1 case was ineffective,where the effective rate was 96.67%,the delayed cure rate was 36.67%,and the ineffective rate was 3.33%,with an incidence of surgery-related complication of 3.33%.Among the 24 patients in the neuroendoscope-guided surgery group,21 cases were cured,and 3 cases were delayed cured,without ineffective cases,where the surgical effective rate was 100%,the delayed cure rate was 12.50%,and the ineffective rate was 0,with an incidence of postoperative complications of 4.17%.There was no significant difference in the cure rate between the two groups,but the delayed cure rate in the microscope-guided surgery group was significantly higher than that in the neuroendoscope-guided surgery group(P<0.05).There was no statistical difference in postoperative complications between the two groups.Conclusions Neuroendoscope-guided microvascular decompression is a safe and effective surgical method for patients with vertebral artery associated hemifacial spasm,which can reduce the delayed cure rate to certain extent.