微血管减压术治疗原发性面肌痉挛57例疗效分析

目的 观察微血管减压术(MVD)治疗原发性面肌痉挛(HFS)的疗效，总结经验，以提高疗效和减少并发症。 方法 回顾性分析太和医院神经外科自2010年6月—2015年6月采用MVD治疗原发性HFS患者的57例临床资料，观察疗效及并发症。 结果 56例患者均有明确的责任血管，占98.2%,分别为小脑前下动脉、小脑后下动脉、椎动脉，责任血管为1支血管或为多支血管。1例术中未见明显责任血管。术中见面神经根部有明显血管压迹12例，其中8例术后抽搐即刻消失，4例抽搐明显缓解。57例患者中术后症状即刻消失51例，明显缓解6例，缓解病例在6个月内症状逐步消失。术后同侧轻度面瘫6例，5例在6个月内逐步恢复，1例随访2年仍有轻度面瘫。同侧听力下降5例，随访6个月～2年改善不明显。1例同侧听力永久性丧失。耳鸣2例，3个月内均自行恢复。眩晕、共济失调2例，1个月内恢复。无脑脊液漏和颅内感染病例，无致残和死亡病例。随访1～4年(平均2.5年)无复发病例。 结论 MVD是面肌痉挛安全、有效的治疗方法。老年HFS患者MVD疗效满意，年龄不是MVD的禁忌。MVD治愈率高、并发症发生率低，应该作为治疗HFS的首选方法。扎实的理论功底和娴熟的显微操作技术是提高疗效和减少并发症的关键。 

Efficacy of microvascular decompression on patients with primary hemifacial spasm

Objective To investigate the efficacy of microvascular decompression(MVD) on patients with primary hemifacial spasm(HFS)and sum up experiences to enhance the curative effects and decrease complications. Methods The data of 57 patients with HFS during June,2010 to June,2015 who had underwent MVD were retrospectively analyzed for the efficacy and complications. Results Fifty-six patients had specific one or more offending vessels,accounting for 98.2 percent,which were respectively anterior inferior cerebellar artery,posterior inferior cerebellar artery as well as vertebral artery.There was no specific offending vessel in one case.Significant vascular pressure trace was seen in facial nerve root of 12 patients in operation.Hemifacial spasm immediately disappeared in 8 patients and hemifacial spasm was obviously relieved in 4 patients after operation.Among 57 patients,symptoms of HFS disappeared immediately after operation in 51 patients and significantly relieved in 6 patients,the symptoms of whom gradually disappeared in 6 months later.Slight facial paralysis appeared in 6 patients after operation and gradually disappeared in 5 patients 6 months later.There was 1 patient with mild facial paralysis followed up for 2 years.Hearing impairment appeared in 5 cases after operation and there was no obvious improvement in 6 months to 2 years.Permanent hearing loss appeared in 1 patient after operation.Tinnitus appeared in 2 patients after operation and disappeared 3 months later.Dizziness and ataxia appeared in 2 patients after operation and disappeared in 1 month.There was neither report of cerebrospinal fluid leakage and intracranial infection,no report of disability and death.No recurrence was noted during the follow-up period of 1 to 4 years(mean 2.5 years). Conclusion MVD is a safe and effective treatment for HFS.Effect of MVD for elderly patients with HFS was satisfying,thus age was not a contraindication of MVD.MVD,with high cure rate and low complication rate,should be the first choice for the treatment of HFS.Solid theoretical foundation and skilled micromanipulation technique are essential to improve the curative effect and reduce complications.