面神经鼓室段梳理术治疗半面痉挛长期疗效观察

对７６４例半面痉挛病人行面神经鼓室段针刺梳理术，术后信访３２６例３～７年，痊愈１０９例（３２．４％），好转１８２例（５５．８％）；总有效率为８９．３％（２９１／３２６）；无效３５例（１０．７％）。对无效的３５例又行第２次或第３次梳理术，术后随访３年，治愈２３例（６５．７％）。     

面神经水平段梳理术治疗半面痉挛

半面痉挛（ＨＦＳ）病因机理不清，有神经冲动短路、局部癫痫、微血管压迫学说，无特效药物治疗。本文报告经鼓室探查进路行面神经水平段减压术治疗ＨＦＳ６例，平均随访１．２年，显效４例，复发２例，但程度减轻，５例术中分离砧镫关节，听力不变。ＨＦＳ行水平段神经梳理术不复杂，安全有效，是多种手术疗法中可取的一种。作者介绍提高手术效果的几点经验；（１）鼓室查术外耳道鼓膜皮瓣比常规大一点，有利于暴露面神经水平段；（     

乙状窦后进路面神经干梳理术治疗半面痉挛

２２例半面痉挛患者行乙状窦后进路面神经干梳理术治疗，均取得良好近期疗效。其中１６例术后观察１～４年，痊愈１１例，显效３例。术中观察面神经有动脉袢压迫者１２例。该手术安全可靠，适应证宽，术后不遗有面瘫，无死亡。对术后听力减退、复发及其他问题进行了讨论。     

面神经鼓室段梳理术治疗半面痉挛长期疗效观察

对７６４例半面痉挛病人行面神经鼓室针刺梳理术，术后信访３２６例３～７年，痊愈１０９例（３２．４％）好转１８２例（５５．８％）总有效率为８９．３％（２９１／３２６），无效３５例（１０．７％），对无效的３５例又行第２次或第３次梳理术，术后随访３年，治愈２３例（６５．７％）。     

颞外段面神经梳理术治疗半面痉挛

半面痉挛是耳神经外科临床少见顽症之一，其为一侧面部肌肉发生痉挛抽搐，病因及机制尚不完全清楚，因此诸多治疗方式存在争议。现将本科1999-2001年收治的17例半面痉挛伴功能障碍较重患者行颞外段面神经梳理术。报道如下。     

面神经垂直段梳理加部分切断术治疗半面痉挛8例

半面痉挛是半侧颜面肌肉阵发性不自主的节律性抽搐,多见于女性及中老年人。我科于2000年3月～2003年3月作面神经垂直段梳理加部分切断术治疗半面痉挛8例,报告如下。     

乙状窦后进路面神经干梳理术治疗半面痉挛(15例报告)

目的探讨乙状窦后进路面神经干梳理术治疗半面痉挛的机理与方法.方法全麻下乙状窦后进路进入桥小脑角,在手术显微镜下对Ⅶ、Ⅷ颅神经周围进行探查,并进行面神经干梳理术.结果15例患者中小脑前下动脉压迫10例,其中合并蛛网膜粘连4例,小脑后下动脉压迫1例,神经根周围未见明显病变者4例.随访6个月～5年,1例一年后复发,1例术后出现了神经性耳聋,经治疗后好转.结论乙状窦后进路面神经干梳理术治疗半面痉挛效果满意,避免并发症的发生也至关重要.     

Outcome following retrosigmoid microvascular decompression of the facial nerve for hemifacial spasm

This paper evaluates the outcome of retrosigmoid microvascular decompression of the facial nerve in a series of patients suffering from hemifacial spasm who had been referred to the skull-base team (comprising senior authors DAM and DGH). The paper is a retrospective review of 15 patients who underwent retrosigmoid microvascular decompression of the facial nerve at Addenbrooke's Hospital between 1985 and 1995. In this series it was possible to obtain complete resolution of hemifacial spasm in 93.3 per cent of cases in the short term and in 80 per cent in the long term. Twelve patients (80 per cent) were symptom-free post-operatively. Two patients had minor recurrence of symptoms occurring within six months of the procedure. One patient with no identifiable vascular impingement of the facial nerve had no improvement following surgery. Three patients suffered sensorineural hearing loss. Two patients complained of post-operative tinnitus, and transient facial palsy was noted in one patient. Retrosigmoid microvascular decompression of the facial nerve provides excellent long-term symptom control in a high percentage of patients with hemifacial spasm.     

Selective facial neurectomy for hemifacial spasm]

Twenty-six patients were treated for hemifacial spasm by selective facial neurectomy. The symptoms of hemifacial spasm can be relieved by performing extracranial selective facial neurectomy with preservation of the temporal and cervical ramus. The facial nerve branches have been identified by selective electrical stimulation over the nerve, which evokes responses from the corresponding facial muscles. Selective facial neurectomy were completed when stimulation of the nerve produces minimal movement in the orbicularis oculi muscle while normal contractions appear in the frontal region and lip portion. The results of surgery 2 years postoperatively indicated that the complete disappearance of hemifacial spasm was achieved in 65.6 percent of the patients. A slight relief was achieved in 15.5 percent of the patients. Unsatisfactory results were obtained in 11.5 percent. No spasm recurred in 7.5 percent of patients, but paralysis of frontal muscle persisted.     

颅内面神经梳刮术治疗半面痉挛29例

目的探讨颅内面神经梳刮术治疗半面痉挛的疗效。方法采用改良乙状窦后径路颅内面神经梳刮术治疗半面痉挛患者29例。术中沿面神经根长轴纵向梳理面神经7~10个层面,再将纤刀面倾斜45°对神经纤维行多层面刮剥,发现面神经根有明显血管压迫且较易分离者加以血管移位隔垫。结果术后面肌抽搐消失25例(86.2%),症状减轻3例(10.3%),总有效率96.6%,无效1例(3.4%)。无感音神经性聋及颅内出血等严重并发症,术后患者出现不同程度面瘫。随访18个月以上,复发2例(6.9%);面瘫均在6个月内恢复,面部肌力恢复达House-brackmannⅠ级或Ⅰ~Ⅱ级。结论对面神经根进行充分有效梳刮、正确判断责任血管并充分移位隔垫是提高颅内面神经梳刮术疗效的关键。     

Ultrastructural changes in the facial nerve root in patients with hemifacial spasm]

Ten facial nerve root specimens obtained from patients with hemifacial spasm were observed under the electronmicroscopy. The axons showed a particular degeneration. Axonal mitochondria and smooth endoplasm showed irregular vacuolization. In severe cases, the mitochondria and smooth endoplasm disappeared. The myelin sheath showed irregular vacuolization, replication, convolution and extensive segmental demyelination. Schwann cells were apparently in a state of degeneration. These changes were not seen in the normal subject. The causes and mechanism of the hemifacial spasm were discussed.     

颅内面神经根梳刮术治疗面肌痉挛

目的：探讨治疗面肌痉挛疗效确切、安全可靠的面神经根显微术式。方法：采用颅内面神经根梳刮术治疗面肌痉挛患者25例。术中见明显血管压迫且易于分离者行血管移位隔垫,同时对面神经根进行适当梳理、刮剥以减少复发;未发现明显责任血管或遇穿通动脉、面神经根被动脉包绕不易移位隔垫血管者,行面神经根梳刮并剪断一小束神经纤维（1／6～1／5）。结果：术后面肌抽搐消失22例（88％）,症状明显减轻2例（8％）,无效1例（4％）。无术后感音神经性聋、颅内出血等严重并发症发生。25例患者术后均出现不同程度面瘫。随访2～8年,面瘫均在1～6个月内恢复,面部肌力基本恢复正常。2年内复发2例（8％）。结论：颅内面神经根梳刮术是治疗面肌痉挛有效的综合显微手术,其并发症少、适应证广且操作简便安全,术中根据不同情况采取相应处理可提高疗效、降低手术风险。     

面肌痉挛责任血管压迫面神经根的解剖特点

目的探讨特发性面肌痉挛（idiopathic hemi facial spasm,IHFS）的面神经根部责任血管的临床解剖特点。方法选择IHFS 160例,在神经根血管减压术中采用显微镜或鼻内镜观察面神经根周围病变。结果可见责任血管154例（96.2%）,依次为小脑前下动脉、小脑后下动脉、小脑上动脉、椎动脉以及两支血管压迫。压迫部位在面神经根入脑桥处151例（98%）,且多居前方,同时伴蛛网膜粘连（107/154,69.5%）。未见血管压迫及占位病变者6例（3.8%）。结论 IHFS责任血管多为一支,也可为两支;压迫部位在面神经根入脑桥处前方,位置隐蔽。因此,神经根血管减压术（micro vascular decompression,MVD）术中应该仔细寻找,以免遗漏责任血管。     

面神经根梳理并部分结扎治疗面肌痉挛疗效及并发症分析

目的探讨治疗面肌痉挛的新方法及并发症预防.方法乙状窦后径路面神经根梳理并部分结扎.结果56例病人手术后疗效令人满意.结论面神经根梳理并部分结扎是治疗面肌痉挛的有效治疗途径之一.