微血管减压术治疗面肌痉挛35例临床体会

目的探讨用微血管减压术治疗面肌痉挛神经血管压迫综合征的临床经验。方法回顾2009年6月至2011年6月我院采用微血管减压术治疗面肌痉挛35例,经乙状窦后入路面神经根微血管减压术,手术时经绒球小结叶显露面神经脑干段,仔细找寻责任血管后,将其推移离开面神经,在血管和脑干之间放置Teflon棉固定。结果术中发现小脑前下动脉26例(74.3%),小脑后下动脉7例(20.0%),椎动脉2例(5.7%),总有效100%,本组无死亡。结论微血管减压术是治疗颅神经血管压迫综合征的有效方法,术中不遗漏责任血管,使责任血管远离面神经是影响手术效果的关键。     

面肌痉挛显微血管减压术中的面神经根解剖变异

目地 探讨小脑脑桥角面神经根解剖变异与原发性面肌痉挛的关系及手术治疗.方法 采用显微血管减压术治疗的1221例面肌痉挛病例中,10例(0.82%)术中探查发现面神经根存在解剖变异,面神经根出脑干区距离听神经根进脑干区均大于10mm.均采用显微血管减压术治疗,其中4例术中采用责任动脉悬吊法.结果 9例患者术后面肌痉挛立即消失,1例患者术后痉挛减轻但未消失,随访5个月时完全消失.所有患者随访2-96个月,平均26.8个月,复发1例,治愈率90%.术后并发症包括:中度面瘫2例,1例随访期间恢复正常,1例轻度恢复;展神经麻痹致复视3例,2例随访期间恢复正常,1例仅随访3个月,有好转;患侧听力丧失1例,随访21个月未恢复.结论 小脑脑桥角面神经出脑干区异位至距离听神经进脑干区大于10mm者罕见,动脉性血管压迫仍然是此类患者原发性面肌痉挛的主要病因,采用显微血管减压术治疗可获良效,但术后发生面瘫、展神经麻痹、听力障碍的概率升高.应用责任动脉悬吊法有利于提高疗效、减少并发症.     

显微血管减压治疗三叉神经痛和面肌痉挛的近期疗效观察

经后颅窝入路对7例三叉神经痛、5例面肌痉挛行显微血管减压手术治疗。7例三叉神经痛患者中有6例发现三叉神经根为动脉压迫,1例为静脉压迫。7例病人于血管减压后疼痛完全消失,且无任何神经缺陷遗留。5例面肌痉挛患者中4例面神经根有动脉压迫。血管减压后症状都获得明显缓解,1例在面神经根部未发现血管压迫,此例术后疗效不佳。微血管对神经根的压迫是三叉神经痛和面肌痉挛的一种重要病因。显微血管减压治疗这两种疾病的近期疗效甚佳,远期疗效尚待进一步观察。     

面神经根解剖变异与原发性面肌痉挛

目的探讨桥小脑角面神经根解剖变异与原发性面肌痉挛的关系。方法回顾性分析2000年10月～2006年6月采用显微血管减压术（MVD）治疗的787例面肌痉挛病例的临床资料。其中5例（0．6％）术中探查时发现面神经根存在解剖变异．面神经根出脑干区距离听神经根进脑干区均大于10mm。均成功行MVD治疗。其中2例采用责任动脉悬吊法。结果5例病人术后面肌痉挛均立即消失。分别随访2、7、14、50、63个月，均无复发。术后并发症：中度面瘫1例，随访期间恢复为轻度：展神经麻痹致复视2例．随访期间恢复正常1例，好转1例。结论桥小脑角面神经根出脑干区异位至距离听神经根进脑干区大于10mm者罕见．动脉性血管压迫仍然是此类病人原发性面肌痉挛的主要病因．采用MVD治疗可获良效．     

不同责任血管处理方式对面肌痉挛微血管减压术疗效的影响

目的探讨面肌痉挛微血管减压术中不同类型的责任血管减压方法及疗效的关系。方法回顾研究我院手术治疗的面肌痉挛患者272例,对责任血管进行分类,并采取不同的减压方法,观察术后疗效。结果典型小脑前下动脉压迫141例,术后治愈率为98．58％;椎动脉和小脑前下动脉联合压迫82例,术后治愈率为95．12％;伴有旁穿支压迫28例,术后治愈率为92．86％;位于面听神经根部之间的压迫21例,术后治愈率为90．48％;总治愈率为96．32％。结论在面肌痉挛微血管减压术中,对不同责任血管采取不同的减压方式可显著提高治愈率。     

神经内镜辅助的锁孔入路微血管减压术治疗原发性面肌痉挛(附68例报告)

目的评价神经内镜辅助的锁孔入路微血管减压术(MVD)治疗原发性面肌痉挛的效果和安全性。方法在神经内镜辅助下,对68例原发性面肌痉挛患者施行锁孔入路MVD,术中通过神经内镜观察面神经根出脑干部位及局部血管的分布和走行情况,确认责任血管,并对手术入路及神经减压方式进行改良,实施减压后观察神经根的松解以及责任血管移位后的状态,术后进行追踪随访。结果手术有效率94.12%(64/68);术后无1例发生脑脊液漏、颅内感染、出血等并发症;术后随访11个月～4年,仅1例复发。结论神经内镜辅助的锁孔入路MVD治疗原发性面肌痉挛是一种创伤小、并发症少、临床效果理想的手术方法。目的评价神经内镜辅助的锁孔入路微血管减压术(MVD)治疗原发性面肌痉挛的效果和安全性。方法在神经内镜辅助下,对68例原发性面肌痉挛患者施行锁孔入路MVD,术中通过神经内镜观察面神经根出脑干部位及局部血管的分布和走行情况,确认责任血管,并对手术入路及神经减压方式进行改良,实施减压后观察神经根的松解以及责任血管移位后的状态,术后进行追踪随访。结果手术有效率94.12%(64/68);术后无1例发生脑脊液漏、颅内感染、出血等并发症;术后随访11个月～4年,仅1例复发。结论神经内镜辅助的锁孔入路MVD治疗原发性面肌痉挛是一种创伤小、并发症少、临床效果理想的手术方法。     

微血管减压术治疗面肌痉挛96例分析

目的探讨微血管减压术治疗面肌痉挛的责任血管、手术疗效以及手术策略。方法回顾性分析采用微血管减压术的96例面肌痉挛病人的临床资料。结果本组术中均能见到血管压迫面神经根出脑干处,均为动脉血管压迫。术后68例症状完全缓解,26例明显减轻,2例手术无效;其中有1例复发。结论微血管减压术是面肌痉挛的有效治疗方法,熟练的显微外科技术,术中责任血管的识别以及减压棉片的放置是影响手术疗效的关键。     

神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效

目的初步探讨神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效。方法回顾性分析山东大学齐鲁医院神经外科2019年6月至2021年3月收治的97例面肌痉挛患者的临床资料。97例患者术前均行影像学检查,以明确责任血管与面神经出脑干区的关系。所有患者均采用神经内镜经小脑绒球下入路面神经显微血管减压术,术中在神经电生理监测下充分解剖后组脑神经背侧的蛛网膜,从而显露面神经出脑干区,明确责任血管,并准确置入垫片。术后疗效评估分为即刻治愈、延迟治愈、复发和未治愈。结果97例患者术中发现责任血管为小脑前下动脉59例;小脑后下动脉3例;椎-基底动脉35例,其中单纯椎-基底动脉8例,椎-基底动脉联合小脑前下动脉24例,椎-基底动脉联合小脑后下动脉3例。术后即刻治愈68例(70.1%)。术后发热13例,听力减退4例,耳鸣2例,一过性面瘫5例。97例患者的术后中位随访时间为9个月(1~19个月),末次随访显示,93例(95.9%)患者的面部抽动完全消失,其中延迟治愈者25例;未治愈者4例;无复发病例。结论神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛,不仅可以提高手术治愈率,而且可以减少术后并发症。     

神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效

目的初步探讨神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛的临床疗效。方法回顾性分析山东大学齐鲁医院神经外科2019年6月至2021年3月收治的97例面肌痉挛患者的临床资料。97例患者术前均行影像学检查,以明确责任血管与面神经出脑干区的关系。所有患者均采用神经内镜经小脑绒球下入路面神经显微血管减压术,术中在神经电生理监测下充分解剖后组脑神经背侧的蛛网膜,从而显露面神经出脑干区,明确责任血管,并准确置入垫片。术后疗效评估分为即刻治愈、延迟治愈、复发和未治愈。结果97例患者术中发现责任血管为小脑前下动脉59例;小脑后下动脉3例;椎-基底动脉35例,其中单纯椎-基底动脉8例,椎-基底动脉联合小脑前下动脉24例,椎-基底动脉联合小脑后下动脉3例。术后即刻治愈68例(70.1%)。术后发热13例,听力减退4例,耳鸣2例,一过性面瘫5例。97例患者的术后中位随访时间为9个月(1~19个月),末次随访显示,93例(95.9%)患者的面部抽动完全消失,其中延迟治愈者25例;未治愈者4例;无复发病例。结论神经内镜经小脑绒球下入路面神经显微血管减压术治疗面肌痉挛,不仅可以提高手术治愈率,而且可以减少术后并发症。     

三叉神经痛合并面肌痉挛1例并文献复习

目的探讨三叉神经痛合并面肌痉挛的临床特点、诊断方法及手术疗效。方法回顾性分析1例三叉神经痛合并面肌痉挛的临床资料,结合文献复习,总结其临床特点、诊断方法、手术方式及术后疗效。结果患者术前MRI 3D-TOF序列提示右侧三叉神经和面神经根区均有血管影存在,对该例患者在电生理监测下行微血管减压手术,术中发现右侧小脑上动脉是三叉神经痛的责任血管,右侧小脑前下动脉是面肌痉挛的责任血管,术后患者三叉神经痛及面肌痉挛症状均完全消失,随访一年余症状未见复发。结论三叉神经痛合并面肌痉挛一般都是血管源性的,术前MRI检查有助于明确诊断和指导手术,微血管减压术是该病唯一的根治性治疗方法。     

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。     

Vascular compression, hemifacial spasm, and multiple cranial neuropathy

Hemifacial spasm is usually an isolated symptom resulting from facial nerve root compression. Three patients had, in addition, tinnitus, hearing loss, facial sensory loss, diminished gag reflex, dysphagia, and dysarthria. Acoustic reflexes were abnormal, and facial nerve conduction studies showed evidence of ephaptic transmission and ectopic excitation. Brain CT and metrizamide cisternography were normal. Surgical exploration showed compression of cranial nerve roots by posterior inferior cerebellar artery branches. After decompression, symptoms abated, and electrical signs of hemifacial spasm disappeared. Vascular compression of nerve roots in the cerebellopontine recess may cause multiple cranial neuropathy.     

显微血管减压术治疗面肌痉挛(附82例分析)

目的探讨显微血管减压术治疗面肌痉挛的责任血管、手术疗效、并发症以及手术策略。方法回顾性分析采用显微血管减压术的82例面肌痉挛病人的临床资料。术前常规行MRI检查排除继发性病因。术中确认责任血管,以Teflon棉分隔。结果本组术中均能见到血管压迫面神经出脑干处(REZ),均为动脉血管压迫,其中小脑前下动脉43例(52.4%),小脑后下动脉25例(30.5%),椎动脉6例(7.3%),多支血管复合型压迫8例(9.8%)。术后58例症状立即完全缓解,24例明显减轻;术后3个月,仅1例未完全缓解。主要合并症包括眩晕、耳鸣15例,听力下降或消失6例,面瘫4例,脑脊液瘘1例,感染4例。无手术死亡。结论显微血管减压术是严重面肌痉挛的首选治疗方式,术中对责任血管的判断和防止脑损伤是确保疗效的关键。     

Hemifacial spasm due to a compression of the facial nerve by a fusiform aneurysm of the vertebral artery: case report]

We report a rare case of symptomatic hemifacial spasm caused by a fusiform vertebral artery aneurysm and by a branch of the anterior inferior cerebellar artery compressing the facial nerve at the root exit zone (REZ). A 71-year-old female had an 11-year history of right hemifacial spasm. MRIs demonstrated an aneurysm compressing the facial nerve at the REZ. Angiography disclosed a fusiform aneurysm of the right vertebral artery at the origin of the posterior inferior cerebellar artery. After the vertebral aneurysm was clipped distal to the origin of the posterior inferior cerebellar artery, a branch of the right anterior inferior cerebellar artery was also observed compressing the facial nerve at the REZ. Both the clipped aneurysm and the branch of the anterior inferior cerebellar artery were mobilized away from the REZ of the facial nerve, and a prosthesis was inserted between the branch of the anterior inferior cerebellar artery and the brain stem to keep the aneurysm away from its original position. The patient's hemifacial spasm immediately disappeared without any neurological deficits just after the surgery. Hemifacial spasm, especially caused by an aneurysm, is quite rare. In a review of the literature, we found only 4 cases of symptomatic hemifacial spasm caused by an aneurysm of the vertebral artery. This case is the first reported case of hemifacial spasm caused by both a fusiform vertebral artery aneurysm and a branch of the anterior inferior cerebellar artery compressing the facial nerve at the REZ.     

面肌痉挛微血管减压术的远期疗效分析

目的探讨影响微血管减压术治疗面肌痉挛远期疗效的因素及提高疗效的方法。方法分析253例随访13～144个月(平均73个月)的资料。结果痉挛消失232例(91.7%),痉挛部分缓解10例(4%),痉挛复发11例(4.3%)。痉挛复发者再手术时发现遗漏压迫血管、减压材料移动是造成手术失败及复发的原因。结论采用微血管减压术治疗面肌痉挛,不遗漏面神经根附近的责任血管,是提高远期疗效的重要环节。     

Hemifacial spasm developed after contralateral vertebral artery ligation

Although the mechanism of hemifacial spasm (HFS) is not yet well established, vascular compression of the facial nerve root exit zone and hyperexcitability of the facial nucleus have been suggested. We report a case of HFS in the setting of coinciding intracranial hemorrhage (ICH) of the pons and proximal ligation of the contralateral vertebral artery (VA) for the treatment of a fusiform aneurysm of the distal VA and discuss the possible etiologies of HFS in this patient. A 51-year-old male with an ICH of the pons was admitted to our hospital. Neuroimaging studies revealed an incidental fusiform aneurysm of the right VA distal to the origin of the posterior inferior cerebellar artery. Eight months after proximal ligation of the VA the patient presented with intermittent spasm of the left side of his face. Pre- and post-ligation magnetic resonance angiography revealed an enlarged diameter of the VA. The spasm completely disappeared after microvascular decompression.     

Hemifacial Spasm Caused by Fusiform Aneurysm at Vertebral Artery-Posterior Inferior Cerebellar Artery Junction

Hemifacial spasm induced by intracranial aneurysm is a rare clinical condition. A 45-year-old male patient presented with a 3-year history of progressive involuntary twitching movement on right face. On radiological study, a dilated vascular lesion compressing the brain stem was found at the junction of vertebral artery and posterior inferior cerebellar artery. On operative field, we found the posterior inferior cerebellar artery and the fusiform aneurysm compressing root exit zone of facial nerve. Microvascular decompression was performed and the facial symptom was relieved without complications.