微血管减压与面神经梳理治疗面肌痉挛

目的探讨治疗面肌痉挛的有效方法。方法对42例面肌痉挛病人行微血管减压加面神经梳理术。结果术后痉挛立即停止者37例,逐渐停止者5例。结论微血管减压加面神经梳理术是治疗面肌痉挛的有效方法,即使术中未发现明确的责任血管。对术后复发的病例,只要正确处理,二次手术仍有效。     

面肌痉挛微血管减压手术技巧及并发症分析(附34例报告)

目的探讨微血管减压术治疗面肌痉挛的手术策略及术后并发症。方法采用微血管减压术治疗原发性面肌痉挛患者34例。术前所有患者均行MRI或MRA检查,排除继发性因素并确定责任血管与面神经关系;分析术中经过及术后并发症。结果术后症状立即消失26例(76.5%,26/34),8例好转;术后并发症:9例耳鸣或听力下降,2例脑脊液耳漏,1例脑脊液鼻漏,1例颅内感染,2例面瘫。未见无效病例。随访6个月～3年,31例治愈,1例术后约1年复发;3例听力下降。结论微血管减压术治疗面肌痉挛效果确切,有针对性的手术策略和细致的手术操作能显著减少并发症的产生。     

微血管减压术后复发和无效的面肌痉挛患者的再手术治疗

目的探讨面肌痉挛微血管减压术后复发或无效病例再手术治疗的安全性及效果。方法对32例微血管减压术后复发的面肌痉挛患者进行术前评估,并再次行手术治疗。分析术后复发的原因,观察再次手术后的疗效。结果再次手术后31例患者治愈,其中28例患者即刻恢复,3例患者延迟恢复;1例患者抽搐未消失。术后早期出现面肌瘫痪者9例、耳鸣5例,2个月内均恢复,1例患者发生永久性听力障碍。术中见,首次手术放置的Teflon棉巨大致密,直接压迫面神经根部17例;责任血管遗漏4例;减压不充分11例。结论再次手术前对复发病例进行安全性评估,选择合适的病例进行再次手术是可行的;再次手术的疗效确切,但手术难度较大。责任血管的遗漏及减压不当是导致复发的主要原因。     

神经内镜辅助显微血管减压术治疗面肌痉挛

目的总结神经内镜在显微血管减压术(MVD)治疗原发性面肌痉挛的应用经验。方法回顾性分析50例运用神经内镜辅助MVD治疗面肌痉挛病例资料,术中运用神经内镜观察术野中面神经走行并辨认其周围责任血管,对受压面神经进行减压。结果术后面肌痉挛症状消失44例,症状减轻6例。术后面瘫3例,听力下降1例。没有无效或复发病例。结论面肌痉挛MVD应用神经内镜能有效避免遗漏责任血管,提高手术疗效,降低术后复发率。     

显微血管减压术治疗面肌痉挛的临床体会(附23例临床报道)

目的探讨面肌痉挛微血管减压治疗的术前评估和手术技巧。方法 23例共21例经MRTA检查确认面神经REZ存在责任血管的面肌痉挛患者,采用乙状窦后入路微血管减压治疗,对比观察术中发现责任血管情况,并随访分析手术疗效。结果 21例经MRTA检查术中20例在面神经REZ发现了责任血管并进行了充分减压,术后21例病人抽搐症状完全消失,2例术后症状减轻,1月后症状消失;术后出现1例患者在术后5d出现迟发性面瘫,经针灸、理疗、药物治疗等处理,1月后治愈;无死亡病例;无脑脊液漏、颅内感染及颅内血肿等严重并发症。结论微血管减压术是血管源性面肌痉挛有效的治疗方法,术前MRTA评估、术中准确判定责任血管并充分减压有助于提高手术疗效。     

复发性面肌痉挛神经内镜下再手术治疗的症状转归

目的总结复发性面肌痉挛单纯神经内镜下再手术治疗的效果。方法对19例曾行显微镜下微血管减压术治疗有效6个月以上又复发的病人,神经内镜下再行面神经手术减压术。结果15例术后症状即消失;3例术后痉挛症状减轻,其中2例两周后消失,1例2个月后消失;1例术后症状无改善。17例获得随访,时间6～24个月,平均14个月,无复发病例。结论神经内镜下再手术是治疗复发性面肌痉挛的安全、有效的方法。     

显微血管减压术治疗面肌痉挛的临床研究 (附1200例报告)

目的 探讨影响显微血管减压术治疗面肌痉挛手术效果及并发症发生的因素。方法 回顾性分析1200例经显微血管减压术治疗的面肌痉挛临床资料。手术采用经绒球小结叶入路显露面神经脑于段．明确责任血管后将其推移，在血管与脑干之问放置Teflon棉固定。术中采用实时脑干听觉诱发电位监测。结果 全部病例术中均发现有明确的压迫血管，责任血管中小脑前下动脉占42．6％，椎动脉为主要责任血管时均伴有多个血管共同压迫面神经根部。全部病例经2～10年随访，平均4．2年．抽搐完全消失88．7％，减轻5．6％，总有效率为94．3％；手术无效2．6％，复发3．2％。听力障碍2．8％。结论 显微血管减压术是面肌痉挛最有效的治疗方法，术中面神经根部的显露、责任血管的识别、减压棉片的放置等是影响手术效果的关键；术中实时脑干听觉诱发电位监测、避龟颅神绎和细小穿支血管损伤．能有效防止听力障碍等并发症发生。     

面肌痉挛的微血管减压治疗

目的探讨微血管减压术治疗面肌痉挛的治疗策略,包括术前诊断评估,手术治疗技巧,并发症防治及疗效等。方法回顾分析52例行微血管减压术治疗原发性面肌痉挛患者的临床资料,所有患者术前有典型面肌痉挛表现,经MRI及MRA检查排除颅内占位性病变及确认责任血管的存在及其与面神经关系。行枕下乙状窦后入路微血管减压术。结果 50例病人术后症状即消失;2例病人术后症状减轻,其中1例半月后消失,另一例3月后消失。术后并发症轻度面瘫3例,耳鸣、听力下降6例,头晕、头痛、呕吐10例,经治疗后恢复,无脑脊液漏、颅内感染、颅内出血等严重并发症,无手术死亡病例。随访期间,1例患者半年后症状复发。结论微血管减压术是治疗原发性面肌痉挛的安全、疗效确切的方式。准确判断责任血管并精细的分离保护神经是关键。     

显微血管减压术治疗三叉神经痛和面肌痉挛的技术差别(附37例报告)

目的为了提高手术安全性和疗效,减少术后并发症,探讨显微血管减压术治疗三叉神经痛和面肌痉挛的方法和技术细节差别。方法回顾性分析37例显微血管减压术手术患者,其中三叉神经痛15例,面肌痉挛22例,分析术中体位,切口,骨窗,责任血管压迫等细节,观察二者术后疗效。结果三叉神经痛患者术后疼痛立即完全缓解14例,1例延迟缓解。所有面肌痉挛患者痉挛症状术后即刻消失,无严重并发症。随访半年~2年,1例三叉神经痛患者复发,所有面肌痉挛患者未见复发。结论显微血管减压术是治疗三叉神经痛和面肌痉挛的有效治疗方法,但在术中体位、切口、骨窗、责任血管压迫等具体操作细节方面有细微差别,了解这些差别有助于增加手术安全性,取得更好的疗效。     

显微手术治疗面肌痉挛合并三叉神经痛（附7例分析）

目的探讨显微手术治疗面肌痉挛合并三叉神经痛的疗效。方法回顾性分析7例面肌痉挛合并三叉神经痛病人的手术经验。均在磁共振检查后行微血管减压治疗,观察术后疗效。结果MRI及术中均见面神经责任血管为小脑前下动脉6例,椎动脉1例;三叉神经责任血管为椎动脉4例,小脑上动脉3例。行微血管减压后,三叉神经痛症状均立即消失;面肌痉挛术后立即消失5例,术后3个月内完全消失2例。结论术前MRI检查可明确诊断并指导手术;微血管减压可有效治疗原发性面肌痉挛合并三叉神经痛。     

神经内镜在三叉神经痛和面肌痉挛手术中的应用

目的 探讨神经内镜在三叉神经痛和而肌痉挛手术中的辅助作用。方法 在显微血管减压术中使用神经内镜，观察神经根进出脑干部位及局部血管的分布和走行情况，确认压迫血管；在实施减压后观察神经根松解情况、垫棉的位置和压迫血管移位后的状态。结果 60例三叉神经痛病例中，56例术后疼痛消失，4例疼痛减轻；40例面肌痉挛病例中，37例术后痉挛消失，3例减轻。平均随访3．2年无一例复发。结论 显微血管减压术中辅助使用神经内镜，能提高手术治疗效果，减少并发症发生。     

面肌诱发肌电图监测下面肌痉挛微血管减压术

目的 探讨面肌诱发肌电图监测下，微血管减压治疗面肌痉挛的有效方法。方法21例术中以面肌诱发肌电图监测寻找责任血管，粗大成袢的责任血管以宽带涤纶条抬起固定于硬膜上，术中用罂粟碱生理盐水冲洗神经根部血管及术野。结果17例术后面肌抽搐立即停止，4例6～61d停止。结论微血管减压术中运用面肌诱发肌电图可明确判断责任血管，证实充分减压，评估预后；粗大成袢的责任血管抬起固定可有效地预防复发；术中罂粟碱应用，有利于减少术后并发症的发生。     

Endoscopic assistance in microvascular decompression of cranial nerves

Microvascular decompression (MVD) is an effective method for treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia (GPN). The aim of this study was to assess the role of endoscopic assistance in MVD for the treatment of cranial neuropathies. Since 2009 till 2011 133 patients with cranial neuropathies were treated by MVD in Burdenko Neurosurgical Institute, Moscow. In 22 patients (11 patients with HFS, 10 patients with TN, 1 with GPN) endoscopic assistance was applied during the MVD. We used minimally invasive retrosigmoid approach in a unilateral position. Cerebellopontine angle was explored by 30-degree or 70-degree telescope to visualize the root entry zone of trigeminal, facial or glossopharyngeal nerves and to locate the neurovascular conflict. In 9 patients with HFS and in 1 patient with TN and in another patient with GPN endoscopy discovered offending vessels that were not visible through the microscope. In all cases endoscope was used to exclude another site of compression and to verify decompression and to identify position of teflon and offending vessel after MVD. Immediately after the surgery excellent outcome was observed in 10 patients with HFS (89%), one patient was reoperated 1.5 years after first operation with positive effect. Relief of pain in early postoperative period was observed in patients with TN and GPN. There were no major complications and postoperative mortality in our series. Endoscopic assistance is very effective and helpful technique in MVD of cranial nerves, especially in cases with HFS. In this study the use of the endoscope allowed to identify the site of compression and to confirm the position of teflon after MVD.     

面肌痉挛微血管减压术后并发症的 相关危险因素分析

目的 探讨面肌痉挛微血管减压术后并发症的相关危险因素。方法 对2012年至2014年治疗的148例面肌痉挛的临床资料进行回顾性分析。统计分析术后出现并发症的种类、发生率及转归,并就术前的一般情况、病程、侧别、面肌痉挛严重程度、骨窗前缘距颞骨岩部内侧面的距离、责任血管的类型及与神经根的关系、蛛网膜的增厚程度、硬膜下操作时间与术后出现并发症的相关性进行Logistic回归分析。结果 148例中,面肌痉挛术后1年缓解率为92.3%,术后均未出现严重并发症,术后2周内出现耳鸣28例（18.9%）、听力下降15例（10.1%）、面瘫12例（8.1%）、发热伴颈项强直10例（6.8%）、颅内感染2例（1.4%）。术后12个月随访,并发症发生情况为听力障碍3例、面瘫2例。骨窗前缘距颞骨岩部内侧面的距离>2 cm（OR=3.167,P=0.038）、责任血管发出穿支血管包绕神经出脑干区（OR=1.674,P=0.027）、分离血管时间>30 min（OR=1.563,P=0.042）与术后并发症的发生有显著相关性。结论 面瘫和听力下降为面肌痉挛术后早期容易出现的并发症,其发生原因主要与术中责任血管的分离困难,增加血管痉挛有关,术中听神经的操作损伤也与术后耳鸣及听力下降等并发症相关。     

Repeat microvascular decompression for hemifacial spasm

OBJECTIVE: To report our experience with repeat microvascular decompression (MVD) for hemifacial spasm (HFS) in patients who have failed their first operation. METHODS: The authors describe 41 redo MVDs for HFS in 36 patients performed over a 3 year period. Seven patients underwent early re-operation after an aborted seventh nerve decompression. Eight patients underwent early re-operation for clinical failure. Eighteen patients underwent late re-operation for spasm recurrence long after their original MVD. Eight MVDs were performed on patients who had already undergone at least two prior operations. RESULTS: Twenty four patients experienced complete spasm resolution (70.6%), eight patients had near total resolution (23.5%), and two patients failed re-operation (5.9%). Two patients were lost to follow up (5.6%). A favourable outcome was reported by 82.4% of patients at a mean follow up interval of 18 months. A total of 91.7% of patients 50 years of age or younger were cured at follow up versus 59.1% of patients older than 50 (p = 0.04). Patients undergoing early re-operation were significantly more likely to be cured or improved than patients undergoing late re-operation (p = 0.03). CONCLUSIONS: Repeat MVD for HFS is effective in experienced hands. Younger patients respond better to repeat MVD. Late repeat MVD for HFS is a reasonable treatment option, although results are less favourable than for early re-operation.     

异常肌反应在面神经显微血管减压术中的应用

目的 探讨异常肌反应(abnormal muscle response,AMR)监测在面神经显微血管减压术(microvascular decolnpression,MVD)中鉴别责任血管、评估减压效果以及判断预后方面的作用.方法 241例典型面肌痉挛患者接受了面神经MVD术中AMR的实时监测,并在术后1周进行疗效评估,分析术中AMR变化与手术预后之问的关系.结果 所有241例患者均在术中记录到典型AMR波形,术后第1周217例(90.0%)患者症状完全缓解.AMR消失组175例,其中165例(94.3%)症状缓解;AMR未消失组66例,52例(78 8%)症状缓解.统计学分析显示AMR消失组的疗效明显好于AMR未消失组(P<0.05).结论 术中AMR监测可辅助判断责任血管,评估减压效果,对提高手术疗效具有较高的应用价值.

Abstract：

Objective Abnormal muscle response( AMR) to the electrical stimulation of a branch of facial nerve is a specific electrophysiological feature of primary hemifacial spasm ( HFS) .Although the correlation between intraoperative AMR findings and postoperative results in patients with HFS has been investigated before, the AMR monitoring has not been employed widely during the microvascular decompression (MVD) surgery.The aim of this study was to evaluate the value of AMR monitoring during MVD, and the correlation between the AMR changes and the clinical outcome.Method This study included 241 cases of MVD.Intraoperative AMR monitoring was performed for each subject.The patients were divided into two groups based on whether the AMR wave disappeared or not following decompression of the facial nerve.Results The AMR disappeared after MVD in 175 patients.Among these 175 patients, 165(94.3% ) patients were relieved from HFS 1 week after HFS.Out of the 66 patients in whom the AMR persisted after MVD, 52(78.8%) patients were relieved.The correlation between intraoperative AMR abolition and HFS relief was statistically significant ( P < 0.05 ) .Conclusions Intraoperative AMR monitoring is an effective assistant for a successful MVD for the patient with HFS.It may be helpful in predicting outcomes in short term and identifying offending vessels,so it should be monitored routinely during MVD.     

Microvascular decompression for hemifacial spasm associated with the vertebral artery

The aim of this study was to discuss the baseline characteristics of hemifacial spasm (HFS) associated with the vertebral artery (VA) and evaluate microvascular decompression (MVD) as a surgical treatment of the associated HFS. From February 2010 to February 2015, 118 consecutive patients with HFS underwent MVD. Of these, 29 cases of HFS were associated with VA, this series was compared with the remaining non-VA-associated HFS. Of the 29 cases of VA-associated HFS, the VA was directly compressing the root exit zone (REZ) in eight cases. In the other 21 cases, the VA contacted REZ indirectly via its branches. The symptoms were completely relieved in 26 cases (89.7%) and partially relieved in another two cases (6.9%). Between the VA-associated group and non-VA-associated group, no statistically significant difference existed in the surgical results. VA-associated HFS is not a rare condition. For all cases of VA-associated HFS, indirect compression due to VA was more common. MVD for VA-associated HFS still can achieve good results.     

Prognostic value of intra-operative abnormal muscle response monitoring during microvascular decompression for long-term outcome of hemifacial spasm

The reliability of intra-operative abnormal muscle response (AMR) monitoring as an indicator of post-operative outcome in patients with hemifacial spasm (HFS) is under debate. The primary aim of this study was to evaluate the correlation between intra-operative AMR changes and long-term post-operative outcome. We monitored intra-operative AMR during microvascular decompression (MVD) in consecutive patients with HFS (n = 104). Patients in this study were divided into two groups based on whether their AMR disappeared or persisted following MVD. Ninety patients were followed-up, and the mean duration from surgery to final follow-up examination was 3.7 years. Fourteen patients were lost to follow-up. AMR disappeared during surgery for 80 patients; of these, 74 achieved complete resolution of HFS, five had persistent HFS, and one patient developed a recurrence of HFS. Of the 10 patients with persistent AMR despite effective MVD, eight patients achieved complete resolution, one patient had persistent HFS, and one developed recurrent HFS. The long-term clinical outcome of HFS after MVD did not significantly correlate with intra-operative AMR changes (p = 0.791). Therefore, we suggest that intra-operative AMR monitoring may not be a reliable indicator of long-term post-operative outcome for HFS.     

微血管减压术治疗面肌痉挛的预后因素分析

目的 探讨影响面肌痉挛微血管减压术的预后因素.方法 回顾性分析2009年6月至2010年10月间我科收治的852例面肌痉挛患者的临床资料、术中所见、电生理监测及疗效情况.通过Logistic回归模型分析影响面肌痉挛患者手术的预后因素.结果 分析结果表明,患者病程长短(P=0.034)、术中发现明确的责任血管(P=0.029)、面神经表面有血管压迹(P=0.000)以及术后异常肌反应(AMR)完全消失(P=0.013)是影响面肌痉挛术后完全缓解的独立预后因素.结论 面神经微血管减压术中应全程探查面神经,寻找是否有神经压迹,对责任血管的准确判断及电生理监测是提高手术疗效的关键.