全程围套式与常规微血管减压术治疗面肌痉挛的对比研究

目的探讨全程围套式与常规微血管减压术治疗面肌痉挛的疗效和显微操作技术。方法回顾性分析两种微血管减压方式治疗65例面肌痉挛患者的术中情况、显微操作技术及结果。按手术方式不同分a组30例，b组35例。按起病时年龄分为C组〈40岁27例，d组〉40岁38例。结果术中a、b两组均发现面神经受压迫有4种模式：单纯接触型，压迫型，黏连包绕型，无明确责任血管型；责任血管包括动脉、静脉、混合性，血管袢；C组术中多见蛛网膜增厚，d组多见血管的构筑改变而致血管解剖移位；a组总有效率80％，复发率13-3％。b组总有效率97．1％，复发率2．9％；并发症随访1年以上未恢复者a组：耳鸣、听力下降10％，共济失调6．7％，面瘫10％；b组：耳鸣、听力下降2．9％，面瘫2．9％。结论全程围套式减压术治疗面肌痉挛更安全、有效；全程解剖分离面神经自进出脑干区域（rootentry／exitzone，REZ）至内听道口。识别责任血管和可疑被压迫部位，置入Teflon棉对面神脑池段全程围套式包裹，避免损伤颅神经和细小穿支血管是影响疗效和减少复发的关键。

Whole-range encirclement method versus conventional method for microvascular decompression for treatment of hemifacial spasm

Objective To compare the efficacy and micromanipulation techniques of microvascular decompression with whole-range encirclment method and the conventional method in 65 cases of hemifacial spasm. Methods The data of 65 surgically managed cases of hemifacial spasm were retrospectively analyzed for intraoperative findings, surgical techniques, and the patients' outcomes. Microvascular decompression with the conventional approach was performed in 30 patients (group A), and whole-range encircling method was used in the other 35 patients (group B). The patients were also divided into group C (below 40 years, n=27) and group D (above 40 years, n=38) according to the onset age of the symptom. Results In these patients, 4 patterns of facial nerve compression were identified: simple contact, contact and indentation, adhesion and encasement, and unidentified offending vessels. The offending vessels included the arteries, veins, and vascular loops. In most patients in group C, the arachnoid membrane around the facial nerve thickened and encircled the offending vessel; in group D, the characteristic changes of the vasculature occurred in the offending artery, resulting in its displacement. In groups A and B, the overall efficaty rate was 80% and 97.1%, with recurrence rates of 13.3% and 2.9%, respectively. The major permanent complications in group A included hearing impairment (10.0%) and ataxia (6.7%), whose incidences in group B were 2.9% and 2.9%, respectively. Conclusion Microvascular decompression with whole-range encircling method is a safe approach associated with high cur rate, in which careful avoidance of injuries to the cranial nerves and the penetrating vessels from the root entry/exit zone and the pons ensure good outcome and minimize the likeliness of recurrence and complications.