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。

Clinical efficacy of endoscopic microvascular decompression for hemifacial spasm via retrosigmoid infrafloccular approach

Objective To preliminarily investigate the surgical effect of endoscopic microvascular decompression for hemifacial spasm via retrosigmoid infrafloccular approach.Methods A retrospective analysis was conducted on the clinical data of 97 patients with hemifacial spasm admitted to the Department of Neurosurgery,Qilu Hospital of Shandong University from June 2019 to March 2021.Ninety-seven patients underwent preoperative imaging examinations to clarify the relationship between the offending blood vessel and the facial nerve root exit zone(REZ).Neuroendoscopy was used to perform microvascular decompression via the infrafloccular approach.During the operation,the arachnoid membrane on the dorsal side of the cranial nerve was fully dissected under neurophysiological monitoring,so as to expose the REZ of facial nerve,clarify the offending blood vessels,and place the Teflon accurately.Postoperative therapeutic effect was evaluated and divided into:immediate relief,delayed relief,relapse,and no relief.Results In 97 patients,the offending vessel was identified to be the anterior inferior cerebellar artery(AICA)in 59 cases,the posterior inferior cerebellar artery(PICA)in 3 cases,and the vertebral-basal artery in 35 cases including 8 cases of merely vertebra-basal artery,24 cases of vertebral-basal artery combined with AICA and 3 cases of vertebral-basal artery combined with PICA.Immediate postoperative relief was achieved in 68 cases(70.1%).After operation,there were 13 cases of fever,4 cases of hearing impairment,2 cases of tinnitus,and 5 cases of transient facial paralysis.The median follow-up time of 97 patients was 9 months(1-19 months).The latest follow-up showed that 93 patients(95.9%)reported complete disappearance of facial spasm,among which 25 achieved delayed relief,and there were 4 cases reporting no relief.There were no cases of recurrence.Conclusion Endoscopic microvascular decompression via retrosigmoid infrafloccular approach could not only improve the relief rate of hemifacial spasm,but also help decrease the incidence of postoperative complications.