微血管减压术治疗面肌痉挛长期随访

目的 评价微血管减压术治疗面肌痉挛的长期随访结果。方法 1994～2004年完成并随访3年以上的面肌痉挛微血管减压术416例，分为两组。A组为早期手术组，210例，B组为近期手术组，206例。结果 患者对该手术满意率A组为81．9％，B组为88．30A，；治愈率A组为78．1％，B组为85．90A，；术后复发率A组为11．9％，B组为8．7％；并发症发生率A组为14．7％，B组为8．2％。结论 提高手术熟练程度，改善操作技巧，彻底分离神经血管周围的蛛网膜，充分减压是获得长期满意效果的重要因素。     

显微血管减压术治疗面肌痉挛无效的原因

目的 探讨显微血管减压术治疗面肌痉挛无效的原因。方法 对23例经显微血管减压术治疗无效的面肌痉挛患者行再次手术,发现责任血管判断失误致主要压迫血管遗漏7例;减压棉片插入位置不当,血管襻未离开面神经根部9例;减压材料选择及操作方法错误5例;责任血管粗大弯曲,而减压棉片过小致血管复位2例。结果 经第2次手术后21例患者症状立即消失,2例面部仍抽搐者分别在术后2周和6周后消失。第2次术后所有患者经1．0～6．0年随访(平均3．4年),无一例症状复发。结论 显微血管减压术是治疗面肌痉挛的有效方法,准确判断责任血管和正确减压是提高手术治疗效果的关键。     

老年骨质疏松椎体压缩骨折行球囊扩张椎体后凸成形术的护理

对35例三叉神经痛和10例面肌痉挛患者采用微血管减压手术治疗，结果治疗总有效率88．9％，随访2．5～3．7年，无复发病例。提出术后严密观察病情，及早采取有效措施预防低颅压，并积极预防和护理口唇疱疹、面神经麻痹、外展神经暂时性麻痹、听力减退等并发症是促进患者康复的关键。     

显微血管减压术治疗面肌痉挛的体会

目的总结应用显微血管减压手术治疗面肌痉挛的临床疗效。方法对51例面肌痉挛患者,实施显微血管减压手术治疗,随访6个月³年,观察手术效果及术后并发症情况。结果治愈32例(62.7%),显效17例(33.3%),无效2例(3.9%)。术后脑脊液鼻漏2例(3.9%),迟发性面瘫1例(2.0%)。2例患者术后1年再次复发。结论应用显微血管减压术治疗面肌痉挛治愈率高、远期并发症少,疗效肯定。     

微血管减压术治疗面肌痉挛围手术期系统护理体会

目的探讨原发性面肌痉挛微血管减压术的围术期护理方法。方法对接受微血管减压术的78例面肌痉挛患者,术前开展心理支持和完善各项准备;术后密切监测病情变化及做好体位、饮食、并发症的预防和护理及出院教育。结果 78患者中52例患者面肌痉挛立即停止,14例患者术后2～4周面肌痉挛停止,10例患者偶有阵发性痉挛,经过治疗,3个月后症状基本消失。2例患者术后症状改善不明显。3例患者术后出现不同程度面瘫,4例听力下降,分别经针灸、药物等治疗后痊愈。未发生脑脊液鼻漏、脑梗死、脑出血等并发症,无死亡病例。结论对接受微血管减压术治疗的面肌痉挛患者,实施围术期系统护理,是保证患者安全度过手术期,减少术后并发症和提高手术效果的重要保证。     

局部注射A型肉毒毒素治疗局限性或节段性肌张力障碍

目的　观察A型肉毒毒素治疗偏侧面肌痉挛、眼肌痉挛、Meige综合征 (睑痉挛 -口颌肌张力障碍综合征 )及痉挛性斜颈的疗效。方法　用A型肉毒毒素对 6 4例肌张力障碍患者 (5 1例偏侧面肌痉挛、10例眼睑痉挛、1例Meige综合征、2例痉挛性斜颈 )行面部肌肉局部多点注射 ,分析其治疗效果。结果　 5 1例偏侧面肌痉挛者 ,完全缓解 2 0例 (4 0 % ) ,明显缓解 30例 (5 9% ) ,1例无效 ;10例眼睑痉挛者 ,5例完全缓解 ,4例明显缓解 ,1例无效 ;1例Meige综合征部分缓解 ;2例痉挛性斜颈者 ,1例明显缓解 ,1例部分缓解 ;总有效率达 97%。起效时间数小时至 7天 ,缓解时间 3～ 7个月。局部副反应轻微、短暂 ,无全身反应及过敏反应。结论　A型肉毒毒素局部肌肉注射可有效控制局部肌张力过高 ,改善患者的异常面容和姿势。     

面肌痉挛显微血管减压术中后组脑神经间隙的应用分析

目的 探讨面肌痉挛显微血管减压术中后组脑神经间隙的应用效果和临床意义. 方法 回顾从2008年5月到2011年12月所施行微血管减压手术治疗面肌痉挛病例,对其中责任血管压迫位于桥延沟的34例,将其涉及的神经间隙进行分型,总结不同的分型进行的术中操作,并观察其临床效果. 结果 34例中,后组脑神经分型:致密型16例(47.1％),疏松型13例(38.2％),孤立型5例(14.7％).术后效果优良30例(88.2％),效果良好2例(5.9％),无效2例(5.9％).术后仅1例出现患侧听力下降,其余无严重手术并发症发生. 结论 利用不同神经间隙的特点进行观察和操作,面肌痉挛显微血管减压术可取得良好的效果.     

神经内镜辅助锁孔入路微血管减压术治疗面肌痉挛34例分析

目的 针对原发性面肌痉挛的发病原因,结合神经内镜技术及锁孔技术探讨神经内镜辅助锁孔入路下微血管减压术在原发性面肌痉挛治疗中的疗效. 方法 对自2008年6月至2010年6月间收治并经神经内镜辅助锁孔入路微血管减压术治疗的34例原发性面肌痉挛患者的临床资料、影像学资料及手术资料进行总结分析. 结果 总计39条责任血管中,动脉接触25条,动脉压迫6条,静脉接触与压迫8条.2条责任血管者9例(26.5％),小脑前下动脉压迫16例,小脑后下动脉压迫10例,椎动脉压迫3例,基底动脉压迫2例,静脉压迫者8例.32例患者随访2年,2例失访,术后20例(58.8％)抽搐症状立即消失,术后1个月内抽搐逐渐停止者10例(29.4％),1例术后1年左右抽搐才逐渐停止(2.9％),1例患者随访2年仍有间断抽搐发作需继续服用药物,1例有轻度同侧听力下降,其他患者症状均有效控制,无复发. 结论 神经内镜辅助锁孔入路微血管减压术是治疗面肌痉挛非常有效的方法,术中应用微创的理念结合神经内镜的优势仔细辨别相关的责任血管,对面神经根部和远端进行全程探查和有效减压,是直接影响术后临床效果的关键.     

108例细微血管减压术治疗面肌痉挛和三叉神经痛围手术期的护理

本文总结了微血管减压(MVD)治疗面肌痉挛和三叉神经痛患者围手术期护理,内容包括术前充分做好准备,术后严密观察对症处理.结果例面及痉挛患者中63位痉挛症状消失,1例缓解,1例复发;42例三叉神经痛患者术后1～2天止痛,1例一周后止痛:优质的围手术期护理,可以减少术后并发症的发生,以利于患者康复     

局部注射A型肉毒毒素治疗局限性或节段性肌张力障碍

目的观察A型肉毒毒素治疗偏侧面肌痉挛、眼肌痉挛、Meige综合征(睑痉挛-口颌肌张力障碍综合征)及痉挛性斜颈的疗效.方法 [ HT5"K〗用A型肉毒毒素对64例肌张力障碍患者(51例偏侧面肌痉挛、10例眼睑痉挛、1例Mei ge综合征、2例痉挛性斜颈)行面部肌肉局部多点注射,分析其治疗效果.结果 51例偏侧面肌痉挛者,完全缓解20例(40%),明显缓解30例(59%),1例无效;10 例眼睑痉挛者,5例完全缓解,4例明显缓解,1例无效;1例Meige综合征部分缓解;2例痉挛性斜颈者,1例明显缓解,1例部分缓解;总有效率达97%.起效时间数小时至7天,缓解时间 3～7个月.局部副反应轻微、短暂,无全身反应及过敏反应.结论 A型肉毒毒素局部肌肉注射可有效控制局部肌张力过高,改善患者的异常面容和姿势.     

面神经根显微神经血管减压梳理牵拉术治疗特发性半面痉挛

目的：解除特发性半面痉挛的病因，提高治愈率。方法：采用乙状窦后进路面神经根显微神经血管减压梳理牵拉术。结果：４３８例特发性半面痉挛，术后随访１～８年以上，治愈４１７例（９５．２％），复发１４例（３．４％）。结论：特发性半面痉挛的病因主要为血管压迫面神经根及其周围的脑干表面，另一病因为面神经核功能异常。认为面神经根显微神经血管减压梳理牵拉术是一种解除病因的治疗方法，治愈率高，复发率低。     

Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships

A series of 152 posterior fossa explorations for tic douloureux and hemifacial spasm has been reviewed with assessment of outcome at the last follow-up examination. Among 103 cases of tic followed for an average of 48.3 months, 79 patients (77%) obtained good or excellent symptomatic relief, and there were 24 failures or recurrences (23%). Of 48 cases of hemifacial spasm followed for an average of 42.1 months, there were good or excellent results in 42 cases (87.5%); only 6 patients (12.5%) experienced failure or recurrence. Patients noted to have arterial contact at the 5th nerve entry zone responded significantly better to microvascular decompression than did patients with no arterial contact. Further, patients noted to have anatomical distortion of the 5th nerve by an artery or wedging of an artery into the crevice between the nerve and the pons had significantly better outcomes after microvascular decompression than did patients with other kinds of arterial contact. Partial sensory rhizotomy proved to be a highly effective alternative to microvascular decompression in cases of doubtful neurovascular compression. It was not possible to define similar neuroanatomical criteria predictive of response to microvascular decompression in patients with hemifacial spasm.     

微血管减压术治疗面肌痉挛合并三叉神经痛的临床疗效观察及安全性探讨

目的观察微血管减压术治疗面肌痉挛合并三叉神经痛的临床疗效,分析微血管减压术的临床应用价值以及安全性。方法选取2008年10月到2011年10月期间在我院住院治疗的52例面肌痉挛合并三叉神经痛患者作为研究对象。随机分为实验组和对照组,每组各26例。实验组患者采取微血管减压术进行治疗,对照组患者采取传统的面神经切断术。结果实验组患者的临床总有效率为96.2%,对照组患者的临床总有效率为69.2%,两组比较差异具有统计学意义(P0.05)。实验组术后不良反应发生率为30.8%,复发率为19.2%;对照组术后不良反应的发生率为65.4%,复发率为50%,两组患者的不良反应和复发率比较差异均具有统计学意义(P0.05)。两组治疗前生活质量评分比较无统计学差异(P0.05),治疗后两组均高于治疗前(P0.05),而实验组又高于对照组(P0.05)。结论微血管减压术治疗面肌痉挛合并三叉神经痛的临床疗效显著,并发症发病率低,不易复发,具有一定的临床应用价值。     

Intra-operative monitoring by facial electromyographic responses during microvascular decompressive surgery for hemifacial spasm

Summary The facial electromyographic response was monitored intraoperatively in 40 patients with hemifacial spasm who were operated on by microvascular decompression of the facial nerve. All 40 patients showed an abnormal facial electromyographic response (lateral spread response) with a latency of about 10 msec after stimulation. The abnormal response resolved before decompression in 22, resolved immediately with decompression in 16, and failed to resolve in two. Of the 38 patients in whom the abnormal response disappeared during surgery, 36 were postoperatively free from hemifacial spasm and two had mild hemifacial spasm. The two patients in whom the lateral spread response did not disappear during surgery showed persistent hemifacial spasm.In conclusion. Disappearance of the lateral spread response during surgery correlated with the absence of hemifacial spasm in the early postoperative period. The prognosis of hemifacial spasm was good in cases in whom the lateral spread response disappeared. Therefore, the authors think that intra-operative facial electromyography is very useful in assessing the efficacy of microvascular decompression and in predicting the prognosis of hemifacial spasm.     

Frequency and prognosis of delayed facial palsy after microvascular decompression for hemifacial spasm

Summary Background. Microvascular decompression (MVD) for hemifacial spasm (HFS) provides a long-term cure rate. Delayed facial palsy (DFP) is not an unusual complication, but it has only been sporadically described in the literature. The purpose of this report is to evaluate the incidence of delayed facial palsy after MVD and its clinical course and final results. Methods. From January, 1998 to April, 2004, 410 patients underwent microvascular decompression for hemifacial spasm at our Institute. During this time, 21 patients (5.4%) developed delayed facial weakness; eighteen of them were given steroid medication and they were followed up in the out-patient clinic. Findings. Twenty-one patients developed DFP after microvascular decompression an incidence of 5.4%. There were seventeen women (81.0%) among the 21 patients with DFP who were included in this study. In twenty of them, the symptoms of HFS improved completely after the operation, but the spasm remained with one of them. The onset of palsy occurred between postoperative day 7 and 23 (average: 12.1 days). The palsy was at least Grade II or worse on the House-Brackmann (HB) scale. The time to recovery averaged 5.7 weeks (range: 25 days–17 weeks); 20 patients improved to complete recovery and 1 patient remained with minimal weakness, as Grade II on the HB scale, at the follow-up examination. Conclusion. Our findings demonstrated that the incidence of DFP was not so low as has been reported the literature, and it did not have any striking predisposing factors. Even though the degree of facial palsy was variable, almost all patients exhibited a complete recovery without any further special treatment. The etiology of DFP and its association with herpes infection should be further clarified.     

Intraoperative monitoring of facial electromyographic responses during neurovascular decompressive surgery for hemifacial spasm]

In this paper, we reported our experience of intraoperative facial electromyographic recordings obtained during microvascular decompression for hemifacial spasm. MATERIALS AND METHODS: Intraoperative electromyographic recordings from the mentalis muscle during stimulation of the temporal branch of the facial nerve has been attempted in 31 patients. No muscle relaxants were used except for those before intubation. Of 31 patients, 22 were female and 9 were male. The age on admission ranged from 31 to 60 years with a mean of 54 years. RESULTS: 1. Abnormal response appeared with a latency of about 10 msec after stimulation. This response disappeared in 30 out of 31 patients at the end of operation. In 4 patients, the abnormal response disappeared prior to decompression of the nerve. 2. 30 patients in whom the abnormal response disappeared were free of spasm immediately after surgery. Hemifacial spasm has been relieved in 28 patients with a follow up period of 6 months to 2 years and 7 months. The remaining two patients had mild spasm. The one patient in whom the abnormal response did not disappear had persistent hemifacial spasm. CONCLUSION: The authors think that intraoperative facial electromyographic recording is useful to identify the blood vessel that is causing the spasm and to ensure that decompression of the nerve has been accomplished.     

Microvascular decompression for hemifacial spasm: a long-term follow-up of 1,169 consecutive cases

We analyzed the records of 1,169 patients with hemifacial spasm (HFS) who underwent microvascular decompression (MVD) and were followed up for more than 6 months from January 1987. The mean follow-up duration was 23.8 months (6-145 months). Excellent surgical outcome was obtained in 90.5% and good in 4.5%, giving an overall success rate of 95.0%. There was statistically significant relationship between vertebral artery (VA) shift and side of symptom. Permanent facial weakness and hearing impairment were 1.4% and 2.3%, respectively. There were no anatomical differences at the root entry zone (REZ) and significant differences of surgical outcome in young HFS (34 patients). Factors such as type of offender, severity of compression on the facial nerve root, and the degree of decompression of the REZ on postoperative MRI did not correlate with surgical outcome.     

微血管减压术治疗颅神经功能亢进性疾患

目的 评价微血管减压术(mierovaseular decompression,MVD)治疗颅神经功能亢进性疾患的疗效.方法 2002年10月-2007年1月,采用MVD治疗106例颅神经功能亢进性疾患.男47例,女59例;年龄42～85岁,平均62岁.三叉神经痛56例,面肌痉挛33例,痉挛性斜颈17例.MRI检查血管压迫神经根明显者60例(56.6%),可疑者33例(31.1%),无压迫者13例(12.3%).病程2～300个月,中位病程54个月.术前典型表现为相应支配区的神经激惹症状.结果 术中发现三叉神经痛患者最常见责任血管为小脑上动脉,共25例(44.6%):面肌痉挛患者为小脑前下动脉,共11例(33.3%):痉挛性斜颈患者为椎基底动脉共14例(82.4%).术后31例发生面瘫、听力下降、面部麻木、眩晕、颈肩疼痛、转颈无力及皮下积液(29.2%),均经对症处理后愈合或改善.患者均获随访,随访时间6～42个月.根据Kobata等疗效评定标准,三叉神经痛者治愈47例(83.9%),面肌瘁挛治愈27例(81.8%),痉挛性斜颈治愈7例(41.2%),总有效率为90.6%;5例(4.7%)无效者,2例再次手术治愈,余放弃治疗.5例(4.7%)于术后3～8个月复发,2例再次手术治愈,1例行伽玛刀治疗好转,余放弃治疗.结论 MVD治疗因血管压迫相关颅神经导致的疾病有较好疗效.完备的术前评估、娴熟的显微手术技巧和术中电生理监护是提高疗效和减少并发症的关键.     

内镜辅助下微血管减压术治疗面肌痉挛的临床分析

目的探讨经内镜微血管减压术治疗面肌痉挛的临床疗效与安全性。方法回顾性分析手术治疗的138例面肌痉挛患者的临床资料,分别采用经内镜微血管减压术(观察组,n=66)和经显微镜微血管减压术(对照组,n=72)。观察比较两组临床治疗效果、复发及术后并发症等情况。结果观察组总显效率明显优于对照组(95.5%VS 83.3%),术后并发症总体发生率和复发率均明显低于对照组(6.1%VS 19.4%、3.0%VS 15.3%),差异均有统计学意义(P<0.05)。均随访1年以上,观察组术后2例轻度面瘫患者在随访期间均康复;对照组术后5例面瘫患者,随访期间有3例明显恢复,3例听力障碍患者1例明显恢复。两组术后出现头晕头痛、皮下积液以及颅内感染在出院前均治愈,均未发生后组颅神经损伤以及颅内血肿。结论应用神经内镜行微血管减压术可以使患者获得更好的临床疗效和手术安全性,值得推广应用。     

A significant correlation between delayed cure after microvascular decompression and positive response to preoperative anticonvulsant therapy in patients with hemifacial spasm

Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), the postoperative course is varied. We retrospectively analyzed the resolution pattern of the spasm and specified predictors for delayed cure after MVD. This study included 114 consecutive patients with typical HFS. All of them were followed up for at least 1 year after operation. Patients were divided into three groups depending on the postoperative course: immediate cure, delayed cure, and failure. To identify the predictive factors for delayed cure after MVD, logistic regression analyses were applied using candidate clinical factors, such as duration of symptom, the tendency of the spasm, preoperative medical treatment, and offending vessels. Among the 114 patients, 107 patients were cured. For those cured, 65 patients were classified as immediate cure and 42 patients were classified as delayed cure. Cumulative spasm-free rates after 1 week, 1 month, and 3 months after MVD were 70, 88, and 97 %, respectively. No predictive factors between the cured and failure groups were observed. According to multivariate analysis, preoperative anticonvulsant therapy was found to be the sole significant predictive factor for delayed cure after MVD (p?=?0.025). A significant correlation between delayed cure and preoperative anticonvulsant therapy was found in our study, which suggests that hyperexcitation of the facial nucleus plays an important role in pathogenesis of delayed cure. Therefore, if a patient demonstrating a positive response to preoperative anticonvulsant therapy showed a persistent spasm after MVD, reoperation should be delayed for at least 3 months after the initial operation.