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。

Microvascular decompression for hemifacial spasm: report of 82 cases

Objective To explore the offending vessels, outcome, complications and surgical strategy of microvascular decompression for hemifacial spasm. Methods The data of 82 patients with hemifacial spasm who underwent microvascular decompression were retrospectively analyzed. MRI examination was taken before operation to exclude secondary cause of disease. The offending vessels were carefully discriminated and separated from root exit zone (REZ) of the facial nerve. Results Offending vessels could be detected at REZ during operation in all the 82 patients, among them the anterior inferior cerebellar artery was the offending artery in 43 cases (52.4%), posterior inferior cerebellar artery in 25 (30.5%), vertebral artery in 6 (7.3%), and vessels complex in 8 (9.8%). Rightly after surgery, symptoms of 58 patients completely relieved, and those of 24 significantly improved. Only 1 patient was not totally relieved in 3 months after the surgery. Major complications included dizziness and tinnitus in 15 cases, hearing loss in 6, delayed facial palsy in 4, CSF leakage in 1, and infection in 4. No patient died due to the operation. Conclusions Microvascular decompression is the first choice for severe hemifacial spasm. The correct discrimination of the offending vessels and avoidance of brain injury during operation are critical to guarantee ideal outcome.