显微血管减压术治疗面肌痉挛的临床研究  

Clinical analysis of microvascular decompression for hemifacial spasm

作　　者：高俊[1] 李智敏[1] 王天宇[1] 李永宁[1] 马文斌[1] 王任直[1] Gao Jun Li Zhimin Wang Tianyu Li Yongning Ma Wenbin Wang Renzhi(Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences ＆ Peking Union Medical College, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经外科,100093

出　　处：《中国微侵袭神经外科杂志》2016年第11期500-502,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的分析显微血管减压术（MVD）治疗面肌痉挛的操作要点和评价其疗效,并探讨术中监测异常肌反应的应用价值。方法回顾性分析采用MVD治疗的186例面肌痉挛病例资料。责任血管为小脑前下动脉98例,小脑后下动脉58例,椎动脉9例,小脑前下动脉和小脑后下动脉共同压迫21例。结果出院时,面肌痉挛症状完全消失142例（76.3%）,痉挛症状改善33例（17.7%）,痉挛症状较术前无明显变化11例（6%）。围手术期脑脊液耳漏1例,术后耳鸣3例,均治愈,无死亡病例。随访6个月～2年,面肌痉挛症状完全消失169例（90.9%）,症状较术前改善14例（7.5%）,症状无改善3例（1.6%）。结论 MVD治疗面肌痉挛安全、有效,术中监测异常肌反应信号有助于判断减压效果,评判手术疗效应考虑延迟治愈的可能。Objective To analyze the operating points and evaluate the therapeutic efficacy of microvascular decompression for hemifacial spasm, and explore the clinical application of intraoperative monitoring of abnormal muscle response. Methods The clinical data of 186 patients with hemifacial spasm undergoing microvascular decompression surgery were analyzed retrospectively. The responsible vessels were the anterior inferior cerebellar artery in 98 cases, the posterior inferior cerebellar artery in 58, the vertebral artery in 9, both the anterior inferior cerebellar artery and posterior inferior cerebellar artery in 21. Results At discharge, hemifacial spasm completely resolved in 142 cases（76.3%）, relieved in 33（17.7%） and had no significant change in 11（6%）. One patient with cerebrospinal fluid leakage and 3 patients with tinnitus were cured completely, and no death occurred during the perioperative period.The patients were followed up for 6 months to 2 years. The symptoms completely disappeared in 169 patients（90.9%）, were improved in14（7.5%） and no improvement was observed in 3（1.6%）. Conclusions Microvascular decompression is safe and effective for treatment of hemifacial spasm. Intraoperative monitoring abnormal muscle response is helpful for judging the effect of decompression. Delayed resolution should be considered during evaluating the surgical effect.

关 键 词：面部单侧痉挛 显微血管减压术 异常肌反应 延迟治愈 

分 类 号：R651.3[医药卫生—外科学]