面肌痉挛138例锁孔下显微血管减压治疗效果及手术技巧  

Curative effect and surgical skills of microvascular decompression via keyhole for 138 cases of hemifacial spasm

作　　者：魏剑波[1] 黄志刚[1] 张明[1] 鄢克坤 王建力[1] 李冬华[1] 吴科[1] 张汝林[1] 

机构地区：[1]四川省攀枝花市中心医院神经外科,四川攀枝花617067

出　　处：《实用医院临床杂志》2011年第6期139-141,共3页Practical Journal of Clinical Medicine

基　　金：四川省卫生厅科研资助项目(编号:100352);攀枝花市应用技术研究与开发资金项目[编号:2010CY-S-1(3)]

摘　　要：目的观察锁孔下显微血管减压术治疗面肌痉挛(Hemifacial spasm,HFS)的效果。方法 138例HFS患者采用锁孔下显微血管减压术手术,锁孔入路显露面神经脑干段,判断责任血管,将Teflon棉放置于面神经与责任血管之间固定;术中采用脑干听觉诱发电位监测。结果 138例术中均发现面神经根部有明确血管压迫,术后面肌痉挛即刻停止106例,1周内停止20例,3月内停止10例,术后复发2例。听力下降5例,听力完全丧失1例。结论显微血管减压术是HFS最有效的治疗方法,术中面神经根部的显露,责任血管的识别,Teflon片的放置等是影响手术效果的关键因素。术中应实时脑干听觉诱发电位监测。Objective To discuss the efficacy of microvascular decompression（MVD） for hemifacial spasm（HFS）.Methods We analyzed the clinical data of 138 cases of HFS by MVD.Through flocculonodular,the root exit zones（REZ） of the facial nerve were exposed via keyhole approach.After identifying the responsible vessels,a pad of Teflon cotton was gently interposed to maintain the separation of the REZ and the responsible vessels.Function of the acoustic nerves was monitored throughout the procedure by means of brainstem auditory evoked potential.Results Vascular compression in the facial nerve roots REZ was found in all patients.Hemifacial spasm stopped immediately after the operation in 106 patients.The post-operative symptom duration was 1 week in 20 patients,3 months in 10 patients.Facial spasm recurred in 2 cases.Five patients had delayed decreased hearing.One had hearing loss.Conclusions MVD is the most effective method for hemifacial spasm.Skilled technique of microsurgery via keyhole approach could lead to minimal operative injury.The exposure of the REZ of facial nerve roots,responsible vessels identification and Teflon insertion are the key factors which affect the efficacy of decompression.Monitoring the brainstem auditory evoked potential in operation can prevent or decrease the complications of MVD,especially dysaudia.

关 键 词：面肌痉挛 显微外科 显微血管减压 疗效 

分 类 号：R746[医药卫生—神经病学与精神病学] R616.2[医药卫生—临床医学]