内镜结合多模态技术在面肌痉挛显微血管减压术中的应用  

Application of endoscopy and multimodal imaging techniques inmicrovascular decompression for hemifacial spasm

作　　者：何宗泽[1] 赵冬冬[1] 杨方兰 陈隆益[1] 张冠妮[1] 胡淼 HE Zong-ze;ZHAO Dong-dong;YANG Fang-lan;CHEN Long-yi;ZHANG Guan-ni;HU Miao(Department of Neurosurgery,Sichuan Academy of Medical Sciences ＆ Sichuan Provincial Peopled Hospital,Chengdu 610072,Operation room;Chengdu 363 Hospital,Chengdu 610041,China)

机构地区：[1]四川省医学科学院.四川省人民医院神经外科,四川成都610072 [2]成都三六三医院手术室,四川成都610041

出　　处：《实用医院临床杂志》2018年第5期39-42,共4页Practical Journal of Clinical Medicine

基　　金：四川省卫计委科研基金资助项目(编号:130203)

摘　　要：目的探讨在锁孔入路面肌痉挛(HFS)显微血管减压术(MVD)中神经内镜和多模态影像技术联合应用的临床价值。方法回顾性分析四川省人民医院神经外科2014年1月至2017年2月收治的130例应用神经内镜辅助锁孔MVD治疗HFS患者的临床、影像、手术资料与随访结果。所有患者术前均行三维时间飞跃法磁共振血管成像扫描(3D-TOF-MRA)检查,术中在神经电生理监测下判别责任血管垫入隔片,同时置入神经内镜行多角度观察面神经全程及其周围血管,观察确认垫片位置。结果本组130例HFS患者术后痊愈122例(93.8%),3例(2.3%)明显缓解,3例(2.3%)部分缓解,2例(1.5%)无效,总有效率96.2%。治疗有效的125例均获得随访,随访时间1年,2例复发,复发率1.5%。结论内镜辅助锁孔入路MVD是治疗HFS非常有效的方法,术前使用多模态3D-TOF-MRA能判断责任血管与面神经的位置关系,术中应用神经电生理监测及神经内镜有助于鉴别责任血管、减少术后并发症、提高手术疗效。Objective To explore the clinical application value of neuroendoscopy and multimodal imaging techniques in microvascular decompression （MVD） for hemifcial spasm （HFS） via keyhole approach.Methods The data of clinical, imaging, opera-tion and follow-up of 130 patients with HFS who were admitted to our hospital and underwent neuroendoscopy-assisted keyhole approach MVD from January 2014 to February 2017 were retrospectively analyzed.All patients underwent the three-dimensional time-of-flight magnetic resonance angiography scan （3D-T0F-MRA） before operation.During the operation,the patients responsible vessels were identified by the neuroelectrophysiological monitoring, and Teflon was placed.At the same time, neuroendoscopy was applied to multi-an-gle exploration of the entire nerve to distinguish the responsible vessels in order to confirm the location of Teflon before and after place-ment.Results After treatment, 122 （93.8% ） cases were completely cured,3 （2.3% ） cases were significantly relieved,3 （2.3%） cases were partial relieved and 2（1.5% ） were unaffected.Thus,the total effective rate was 96.2% .There were 125 patients were suc-cessfully followed-up for one year.During the period of follow-up,2 patients recurred so that the recurrence rate was 1.5%.Conclusion MVD via neuroendoscopy-assisted keyhole approach is an effective treatment for HFS.Multimodal imaging techniques 3D-TOF-MRA can clear estimate the location of responsible blood vessels and facial nerve.Neurophysiological monitoring and endoscopy in the MVD operation can help to identify the responsible blood vessel,reduce the postoperative complications and improve the surgical efficacy.

关 键 词：面肌痉挛 神经内镜 多模态影像技术 显微血管减压术 

分 类 号：R442.6[医药卫生—诊断学]