面肌痉挛的显微血管减压手术治疗

目的 探讨面肌痉挛术前病因诊断方法和术中不同压迫血管的类型与疗效的关系。方法 对215例保守治疗无效的面肌痉挛患者全麻下行显微篾这减压手术治疗。全部病例术前行MRI检查以排除占位性病变；其中145例术前行磁共振断层血管成像（MRTA）检查。结果 常规MRI不能显示压迫血管，而MRTA检查面神经微血管压迫的阳性率达82．8％，为手术病例的选择和术中责任血管的把握提供了可靠依据。本组病例手术优良率91．2％，平均2年以上随访复发率3．5％，无死亡与致残。轻微手术并发症7．9％，主要有一过性耳闷，听力下降，一过性脑脊液鼻漏，伤口迁延愈合等。结论 术前MRTA检查可取代普通MRI作为面肌痉挛术前病因诊断的最佳手段；熟练的显微外科技术以及术中正确识别责任血管并予充分减压是确保显微血管减压术高效、安全的关键。

Microvascular decompression for hemifacial spasm: experience of 215 cases

OBJECTIVE: To investigate the relationship between pre-operational etiological diagnosis of medically intractable hemifacial spasm (HFS) and patterns of offending vessels and the curative effect of microvascular decompression (MVD). METHODS: Two hundred and fifteen patients with medically intractable HFS underwent MVD under general anesthesia. Pre-operative MRI examination was made for all cases to exclude space occupying lesion and magnetic imaging tomographic angiography (MRTA) was conducted for 145 cases of them instead of routine MRI. RESULTS: Routine MRI failed to provide information about offending vessels except for ruling out mass lesions whereas MRTA revealed the offending vessels with a positive rate of 82.8%, thus helping make correct diagnosis and operation decision. Follow-up of more than two years showed that the surgical intervention achieved a high relief rate of 91.2% without major complication, and with a low recurrence rate of only 3.5% after averaging more than two years' follow-up. CONCLUSION: Pre-operative MRTA can replace conventional MRI as a best approach for pre-operational etiological diagnosis of facial spasm. It helps perceive the offending vessels before operation. Skilled microsurgical technique along with correct recognition and mobilization of offending vessels are a must to assure MVD a high efficacious and low risk treatment of choice for HFS patients.