目的 探讨面神经显微血管减压手术中困难减压的处理措施及其效果。方法 回顾性分析2019-01至2023-10在武警北京总队医院行面神经显微血管减压术中31例困难减压患者的临床资料,对于术中脑膨出、蛛网膜严重粘连、复杂责任血管等困难减压类型,进行针对性处理并观察其手术效果。结果 本组20例(66.66%)面肌痉挛症状完全消失,属于完全缓解;7例(22.58%)仍有程度不同的面肌痉挛症状,属于部分缓解; 4例(13.33%)症状无变化。随访6个月后,3例仍存在轻度的面部抽动,较术前明显缓解,总体治愈率为90.33%。结论 对于面神经显微血管减压术出现困难减压的情况,可以通过术前细致的评估、术中灵活多样的困难减压应对处理措施,同样可以获得较好的手术疗效。
Abstract
Objective To investigate the treatment measures of difficult decompression in facial nerve microvascular decompression and its effect. Methods The clinical data of 31 patients with difficult decompression who underwent facial nerve microvascular decompression in Beijing Municipal Corps Hospital of Chinese People’s Armed Police Force from January 2019 to October 2023 were retrospectively analyzed. The types of difficult decompression such as intraoperative encephalocele, severe arachnoid adhesions and complex responsible blood vessels, were targeted and the surgical effects were observed. Results The symptoms of hemifacial spasm disappeared completely in 20 patients (66.66%), which was a complete remission. Seven patients (22.58%) still had facial spasm symptoms of varying degrees, which were partially relieved. Four cases (13.33%) had no change in symptoms. After 6 months of follow-up, 3 patients still had mild facial tics, which was significantly relieved than before surgery, and the overall cure rate was 90.33%. Conclusions In the case of difficult decompression during facial nerve microvascular decompression, a good surgical effect can be obtained through careful preoperative evaluation and flexible and diverse intraoperative difficult decompression measures.
关键词
面肌痉挛 /
显微血管减压 /
困难减压 /
处理措施
Key words
hemifacial spasm /
microvascular decompression /
difficult decompression /
treatment measure
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 中国医师协会神经外科医师分会功能神经外科专家委员会,北京中华医学会神经外科学分会,中国显微血管减压术治疗颅神经疾患协作组.中国显微血管减压术治疗面肌痉挛专家共识(2014)[J].中华神经外科杂志,2014,30(9):949-952.
[2] Nugroho S W,Perkasa S A H,Gunawan K,et al.Predicting outcome of hemifacial spasm after microvascular decom pression with intraoperative monitoring: a systematic review[J]. Heliyon,2021,7(2):e06115.
[3] Holste K,Sahyouni R,Teton Z, et al.Spasm freedom following microvascular decompression for hemifacial spasm; systematic reviewand meta-analysis[J]. World Neurosurg, 2020, 139: e383-e390
[4] 观龙彬,容嘉彬,吴 勇,等.特发性面肌痉挛术后迟发性面瘫的危险因素分析及预防[J].医学综述,2020,26(5):1017-1020,1026.
[5] Park J S,Koh E J,Choi H Y,et al. Characteristic anatomical conforma tion of the vertebral artery causing vascular compression against the root exit zone of the facial nerve in patients with hemifacial spasm[J].Acta Neurochir(Wien),2015,157(3):449-454.
[6] Sindou M,Mercier P. Microvascular decompression for hemifacial spasm:outcome on spasm and complications.A review[J].Neurochirurgie,2018,64(2):106-116.
[7] 魏宜功,周 焜,邓小鹏,等.脑神经疾病微血管减压术不同开颅术式的可行性及疗效分析[J].中国实用神经疾病杂志,2021,24(14):1227-1231.
[8] Wilkinson M F,Chowdhury T,Mutch W A,et al.Analysis of facial motor evoked potentials for assessing a central mechanism in hemifacial spasm[J].J Neurosurg,2017,126:379.
[9] Lee S,Joo K M,Park K. Challenging microvascular decompression surgery for hemifacial spasm[J]. World Neurosurg,2021,151: e94-e99.
[10] Zhao K,Wang J W,Liu W H,et al.Flat-shaped posterior cranial fossa was associated with poor outcomes of microvascular decompression for primary hemifacial spasm[J]. Acta Neurochir (Wien),2020,162(II): 2801-2809.
[11] Wilkinson M F,Kaufmann A M. Facial motor neuron excitability in hemifacial spasm:a facial MEP study[J].Can J Neurol Sci,2014, 41:239.
[12] Mcgahan B G,Albnette-Felicio T,Kreatsoulas D C,et al.Simultaneous endoscopic and microscopic visualization in microvascular decompression for hemifacial spasm[J].Oper Neurosurg,2021,21(6):540-548.
[13] Xue F,Shen Z,Wang Y,et al.Microvascular decompression for hemifacial spasm involving the vertebral artery:a modified effective technique using a gelatin sponge with a FuAiLe medical adhesive[J].CNS Neurosci Ther,2021,27(7):857-861.
[14] El Refaee E,Fleck S,Matthes M,et al.Outcome of endoscope-assisted microvascular decompression in patients with hemifacial spasm caused by severe indentation of the brain stem at the pontomedullary sulcus by the posterior inferior cerebellar artery[J].Oper Neurosurg,2021,20(6):E399-E405.
[15] Lee M H,Lee S,Park S K,et al.Delayed hearing loss after microvascular decompression for hemifacial spasm[J].Acta Neurochir,2019,161(3):503-508.
[16] Lin C F,Hsu S P C,Pan S Y,et al.An easy adjustable sling technique of ectatic vertebral artery transposition for microvascular decom pression[J]. World Neurosurg,2021,154:78.
[17] 邢亚洲,王新军,梁庆华,等.面肌痉挛微血管减压术中困难减压的处理措施及其疗效分析[J].中华神经医学杂志,2017,16(8):831-835.
PDF(1582 KB)
