特发性面肌痉挛显微血管减压术后复发或无效的病因分析及再次手术治疗效果  

Cause analysis of recurrence or ineffectiveness after microvascular decompression for primary hemifacial spasm and efficacy of reoperation

作　　者：甄雪克[1] 邵旭[1] 任鸿翔[1] 许骏[1] 侯晓楠[2] 于炎冰[1] Zhen Xueke;Shao Xu;Ren Hongxiang;Xu Jun;Hou Xiaonan;Yu Yanbing(Department of Neurosurgery,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pediatrics,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院神经外科,北京100029 [2]中日友好医院儿科,北京100029

出　　处：《中华神经外科杂志》2024年第8期832-836,共5页Chinese Journal of Neurosurgery

基　　金：北京市自然科学基金(L222034);中日友好医院高水平医院临床业务费专项(2022-NHLHCRF-YS-05-01)。

摘　　要：目的探讨特发性面肌痉挛(HFS)经显微血管减压手术(MVD)治疗后复发或无效的原因,以及再次行开颅手术治疗的策略及预后。方法回顾性分析2023年2月至2024年4月中日友好医院神经外科同一术者收治的55例MVD治疗后复发或无效的HFS患者的临床资料。所有患者均行再次开颅手术治疗。根据术中所见分析HFS复发或无效的原因,并据此将患者分为3类:原手术垫棉与面神经及其出脑干区(REZ)存在严重粘连者为Ⅰ型;首次手术时遗漏血管[主要为小脑前下动脉(AICA)和(或)小脑后下动脉(PICA)]者为Ⅱ型;首次手术时未对责任血管进行全程有效减压,即责任血管的一部分仍压迫REZ和(或)面神经者为Ⅲ型。对不同类型的患者分别采取相应的再次手术策略。术后采用Cohen-Albert量表评估面肌痉挛缓解程度。所有患者进行临床随访,统计手术疗效和并发症情况。结果55例患者中,复发28例,无效27例。28例复发患者中,Ⅰ型18例(64.3%),Ⅱ型7例(25.0%),Ⅲ型3例(10.7%);27例治疗无效患者中,Ⅱ型21例(77.8%),Ⅰ型、Ⅲ型各3例(11.1%)。28例Ⅱ型患者中,14例(50.0%)遗漏的责任血管为AICA,9例(32.1%)为PICA,5例(17.9%)为椎动脉复合体。6例Ⅲ型患者中,责任血管为AICA者4例,PICA者2例。55例患者进行了(7.2±2.1)个月(2~18个月)的随访。至末次随访,术后Cohen-Albert量表评分为0分者52例,1分1例,2分2例,治愈率为94.5%(52/55),有效率为96.4%(53/55)。随访期间9例(16.4%)出现不同程度的面瘫,6例(10.9%)出现听力下降。结论对于HFS经MVD治疗后复发或无效的患者,可根据再次手术的术中发现将复发或无效病因分为3种类型;根据不同病因类型采用针对性的再次手术方式是治疗该类患者有效、安全的外科手段。Objective To investigate the reasons for the recurrence or ineffectiveness after microvascular decompression(MVD)for primary hemifacial spasm(HFS),as well as the strategies and efficacy of reoperation.Methods A retrospective analysis was conducted on the clinical data of 55 patients with recurrent or ineffective HFS after MVD,treated by the same surgeon in the Department of Neurosurgery at the China-Japan Friendship Hospital from February 2023 to April 2024.All patients underwent reoperation.Based on intraoperative findings,the reasons for recurrence or ineffectiveness were categorized into 3 types:TypeⅠinvolved severe adhesion between the original padding and the facial nerve and its root exit zone(REZ);TypeⅡresulted from the omission of vessels(mainly anterior inferior cerebellar artery and/or posterior inferior cerebellar artery)during the first surgery;and TypeⅢoccurred when offending vessels were not completely and effectively decompressed,meaning that part of the offending vessels continued to compress the REZ and/or facial nerve.Corresponding reoperation strategies were employed for different types of reasons.The Cohen-Albert scoring system was used to assess the degree of hemifacial spasm relief postoperatively.All patients underwent clinical follow-up,and the surgical efficacy and complications were documented.Results Among the 55 patients,28 experienced recurrence,and 27 showed ineffectiveness after the initial MVD.Among the 28 recurrent cases,18 were TypeⅠ(64.3%),7 were TypeⅡ(25.0%),and 3 were TypeⅢ(10.7%).Among the 27 ineffective cases,there was 21 cases of TypeⅡ(77.8%),and 1(11.1%)of TypeⅠand 1(11.1%)of TypeⅢ.Of the 28 missed offending vessels,14(50.0%)were anterior inferior cerebellar artery(AICA),9(32.1%)were posterior inferior cerebellar artery(PICA),and 5(17.9%)were vertebral artery complex.Among the 6 cases where offending vessels were not fully decompressed,4 were AICA,and 2 were PICA.According to the different types,the corresponding reoperation treatment strategy was adopted

关 键 词：面部单侧痉挛 复发 再手术 治疗结果 显微血管减压术 病因 

分 类 号：R651.1[医药卫生—外科学]