微血管减压术治疗面肌痉挛术后并发症分析

目的探讨微血管减压术（microvascular decompression,MVD）治疗面肌痉挛术后并发症原因及处理。方法对2000年12月～2007年3月我院207例面肌痉挛行MVD术后进行1年以上的随访,观察相关并发症的发生及恢复情况。结果无一例死亡,15例（7.2%）在术后1周内出现脑脊液漏皮下积液,给予加压包扎（13例）,穿刺抽吸后加压包扎并头高脚低位（2例）处理后出院时积液基本消失,48例（23.2%）出现面瘫,20例（9.7%）出现听力下降,12例（5.8%）出现耳鸣。术后随访1～7.3年,（4.2±2.7）年,无一例发生脑脊液漏及颅内感染,面瘫及耳鸣患者全部恢复,10例（4.8%）仍有听力障碍,其中6例（2.9%）为耳聋。结论脑脊液漏、皮下积液、面瘫、耳鸣、听力下降是MVD的主要并发症,脑脊液漏、皮下积液、面瘫、耳鸣可逆转,听力障碍是远期主要的并发症,术中注重操作技巧可减少并发症的发生。

Analysis of Postoperative Complications of Microvasular Decompression for Hemifacial Spasm

Objective To investigate the causes and therapy of complications of microvascular decompression （MVD） for hemifacial spasm （HFS）. Method Totally 255 cases of HFS underwent MVD in our hospital from December 2000 to March 2000. Among the cases, 207 patients were followed up for more than 1 year, the occurrence and recovery of their postoperative complications were reviewed in this study. Results In this series, no patient died; cerebrospinal fluid leakage was detected in 15 patients （7.2%） in one week after the operation; facial palsy occurred in 48 cases （23.2%） ; hearing deficit was shown in 20 patients （9.7%） ; and tinnitus was found in 12 cases （5.8%）. The patients were followed up for 1 to 7.3 years with a mean of （4.2 ±2.7） years, during the period, none of the cases had cerebrospinal fluid leakage or intracerebral infection, and the cases who had facial palsy and tinnitus recovered completely; only 10 patients remained hearing deficit （including unilateral deaf in 6） during the follow-up. Conclusion Cerebrospinal fluid leakage, facial palsy, hearing deficit, tinnitus are the major complications of MVD, among which cerebrospinal fluid leakage, facial palsy, and tinnitus can be improved after treatments, but hearing deficit is non-reversible.