两种手术方法治疗特发性半面痉挛的远期疗效

目的　从长期临床疗效证实特发性半面痉挛 (idiopathichemifacialspasm ,IHFS)的病因 ,分析比较显微血管减压术 (microvasculardecompression ,MVD)和显微神经血管减压神经梳理牵拉术(microneurovasculardecompressionneurocombingneurotractiondraw ,MVDCTD)治疗特发性半面痉挛的远期疗效。方法　随访 1985年以来资料完整、手术时间超过 3年以上的患者 5 5 4例。结果　MVD148例 ,观察时间最长者 13年 9个月 ,治愈 117例 ,治愈率 79 0 5 % ;复发 31例 ,复发率 2 0 95 %。MVDCTD 40 6例 ,观察时间最长者 12年 3个月 ,治愈 374例 ,治愈率 92 12 % ;复发 32例 ,复发率 7 88%。 6 3例复发病例中 38例在手术后 2年之内复发。并发症 :听力下降 31例 (2 85 % ) ,轻度耳鸣 2 2例 (2 0 2 % ) ,1度面瘫 78例 (7 18% ) ,颅内感染 34例 (3 13% )。结论　血管压迫面神经根为特发性半面痉挛的主要病因 ,面神经核功能异常也为其原因之一。MVDCTD治愈率高 ,复发率低 ,长期疗效稳定 ,优于MVD。

Long-term observation on two types of surgical operations for idiopathic hemifacial spasm

Objective To evaluate and compare the long term curative effects of two types of surgical operations, microvascular decompression (MVD) and microneurovascular decompression neurocombing neurotraction draw (MVDCTD) for idiopathic hemifacial spasm (IHFS) Methods Five hundred and fifty four patients with complete medical records and with at least 3 year followed up had been collected since 1985 Results Of 148 MVD treated cases with the longest follow up of 13 years and 9 months, 117 cases were free of symptoms, giving a 79 05% cure rate Thirty one patients had recurrence of the symptoms, giving a 20 95% recurrence rate Of 406 cases treated by MVDCTD with the longest follow up of 12 years and 3 months, 374 were cured, giving a 92 12% cure rate, and 32 had recurrences of symptoms, giving a 7 88% recurrence rate Most of them recurred within 2 years after the operation Complications were sensorineural hearing loss in 31 patients (23 temporary,8 permanent),temporary tinnitus in 22,temporary postoperative facial weakness in 78, and postoperative meningitis in 34 ( 3 13%,33 cases were controlled with antibiotics and 1 patient died) Conclusion The vascular compression at the root of the facial nerve is a main cause of IHFS, and the abnormal function of the facial nucleus is also one of the causes MVDCTD for IHFS is characterized by its high curative rate, low recurrent rate and stable long term effect, and is superior to the MVD