摘要
目的探讨显微血管减压术治疗面肌痉挛的疗效。方法回顾性分析采用显微血管减压术治疗的57例面肌痉挛病人的临床资料。术前常规行磁共振断层血管成像检查排除继发性病因并初步确定造成面肌痉挛的责任血管。术中确认责任血管,以Teflon棉分隔。同时术中实时行面肌诱发肌电图监测,观察MD-OC反应。结果本组术中均能见到血管压迫面神经出脑干区,且均为动脉压迫,其中小脑前下动脉(AICA)31例(54.4%),小脑后下动脉(PICA)14例(24.6%),椎动脉(VA)3例(5.3%),复合型压迫9例(15.8%)。至手术结束时有49例MD-OC反应消失,经随访42例临床痊愈,6例症状减轻,1例复发;另有8例手术结束时MD-OC反应仍未消失,经随访3例临床痊愈,5例无效或复发。结论显微血管减压术是严重面肌痉挛的首选治疗方式,完善的术前评估和熟练的手术技巧可以提高疗效和减少并发症的发生。同时,术中面肌诱发肌电图监测有助于判断手术预后并显著提高减压手术的长期疗效。
Objective To explore the effect of microvascular decompression （MVD） for hemifacial spasm. Methods The data of 57 patients with hemifacial spasm who underwent microvascular decompression were retrospectively analyzed. MRTA was taken preoperatively to exclude other secondary causes of the disease and determine the offending vessels preliminarily. During surgery the offending vessels were carefully identified and separated from the root exit zone（REZ） of the facial nerve. Meanwhile, facial evoked EMG monitoring was performed and the MDOC response was observed. Results The offending vessels could be detected at REZ during surgery in all the 57 patients, among them the anterior inferior cerebellar artery was the offending artery in 31 cases（54.4%）, posterior inferior cerebellar artery in 14（24. 6%）, vertebral artery in 3 cases（5. 3%）, and vessels complex in 9（15. 8%）. Of the 49 patients in whom MD-OC response disappeared during surgery, 42 patients showed completely disappearance of hemifaeial spasm, 6 showed partially relief of symptoms and 1 showed recurrence according to the follow-up results; Of the 8 patients in whom MD-OC response did not disappear during surgery, 3 patients showed completely disappearance of hemifacial spasm, 5 showed inefficacy or recurrence. Conclusion Mierovascular decompression is the first choice for severe hemifacial spasm. Comprehensive preoperative evaluation and skillful surgical techniques should be applied to improve the outcome and prevent possible complications. Meanwhile, intraoperative facial evoked EMG monitoring can help to predict the prognosis and improve the long-term results for hemifacial spasm treated with MV-D. response
出处
《立体定向和功能性神经外科杂志》
2009年第4期225-228,共4页
Chinese Journal of Stereotactic and Functional Neurosurgery
