面肌痉挛临床诊断和治疗方法的探讨(附431例报告)

Different treatment modalities for hemifacial spasm (Report of 431 cases)

目的回顾性总结面肌痉挛临床诊断与治疗的经验,比较内外科各种治疗方法的优缺点,探讨术前MRTA影像学诊断的价值。方法对431例曾行各种药物、针灸、A型肉毒素注射、茎乳孔面神经干部分毁损、面神经减压梳理术等方法治疗无效的病人行微血管减压手术。结果431例面肌痉挛病人术前诊断发现继发性病因3例,其中桥小脑角脑膜瘤1例、胆脂瘤2例。在MRTA检查的336例中发现症状侧存在责任压迫血管273例,阳性率达81.3％。MVD术后面肌痉挛症状停止者396例,手术有效率达91.9％。无手术死亡及致残。术后平均随访2.8年,复发率2.9％。3例肿瘤继发性面肌痉挛术后症状立即消失。结论面肌痉挛病人有必要行磁共振检查以明确病因。微血管减压术是目前治疗面肌痉挛最有效的方法,适合任何要求根治且能耐受全麻的病人。熟练的显微外科技术和丰富的临床经验是确保手术安全、高效的关键。

Objective To summarize the clinical experience in diagnosis and treatment of hemifacial spasm (HFS) with different modalities. Methods 431 patients with HFS received medication, acupuncture, botulinum A toxin injections, and extracranial facial nerve ablation prior to microvascular decompression (MVD) operation in meurosurgery department of Rai Jim Hospital. Results Three cases (of HFS) were found to be due to secondary causes, one of CPA meningioma and two cholesteatomas. Magnetic resonance tomographic angiography (MRTA) evaluation helped to discern offending vessels in 273 out of 336 cases with a positive rate of 81.3%, completely consistent with intra-operative findings. The false positive and false negative rates were 8.3% and 10.4% respectively. MVD operation revealed 92% successful rate with no major complications. Recurrence rate was 2.9% after an average of 2. 8 years' follow-up. Conclusions MRTA check-up before operation is necessary to peer into the etiology of hemifacial spasm, which benefits the surgical planning. MVD operation proves to be a reliable and safe treatment of choice for the patients in experienced hands and is adapted to all patients who wish to cure the symptom and can sustain general anesthesia.