显微血管减压术治疗面肌痉挛的经验总结及分析

doi:10.3877/cma.j.issn.2095-123X.2020.04.010

目的

总结分析显微血管减压术（MVD）治疗面肌痉挛（HFS）的手术经验。

方法

回顾性分析辽宁省人民医院神经外科自2017年1月至2018年12月收治的414例行MVD治疗HPS患者的临床资料，观察手术有效率及并发症的发生率。

结果

所有患者随访18~52个月，平均40.8个月，无死亡病例。术后即刻有效率为98.07%（406/414），并发症主要包括听力下降、耳鸣、头晕、迟发性面瘫及脑脊液瘘等，但多为一过性，术中责任血管多数为小脑后下动脉，其后是小脑前下动脉和椎动脉参与压迫；远期有效率为99.03%（410/414），远期并发症主要包括听力下降，耳聋及耳鸣等，暂无复发病例。

结论

MVD手术是一种安全、有效的治疗HPS方法，熟练的掌握MVD手术技巧、术中耐心细致的处理和术后谨慎防治并发症，奠定了一台MVD手术成功的基础。

关键词: 面肌痉挛, 显微血管减压术, 颅神经

Objective

To summarize and analyse the experience of microvascular decompression (MVD) in the treatment of hemifacial spasm (HPS).

Methods

Four hundred and fourteen patients with HFS, admitted by neurosurgery department of The People’s Hospital of Liaoning Province from January 2017 to December 2018, were analysesed retrospectively. All of the patients underwent MVD procedure. The efficiency and incidence of complication of postoperation were collected.

Results

The follow-up time ranged from 18 to 52 months in all patients (mean 40.8 months). There were no deaths. The instant efficiency was 98.07% (406/414). The postoperative complications mainly include hearing loss, tinnitus, vertigo, delayed facial paralysis and cerebrospinal fluid fistula, but most of them were transient. Most of the offending vessels were posterior inferior cerebellar artery, followed by anterior inferior cerebellar artery and vertebral artery. After follow-up, the long term efficiency was 99.03% (410/414). The long term complications mainly include hearing loss, total hearing loss and tinnitus. Up to date, there was no recurrent patient in this study.

Conclusion

MVD is a safe and effective method to treat HFS. Mastering the technology skillfully, manipulating properly during procedures and preventing from postoperative complications carefully lay the foundation for a successful MVD operation.

Key words: Hemifacial spasm, Microvascular decompression, Cranial nerve

表1 患者显微血管减压术术后即刻和远期并发症汇总[例（%）]

并发症	即刻并发症	远期并发症
听力下降	36(8.70)	12(2.90)
耳聋	3(0.72)	3(0.72)
耳鸣	18(4.35)	5(1.21)
面瘫	26(6.28)	2(0.48)
头晕	45(10.87)	1(0.24)
一过性脑脊液瘘	16(3.86)
切口愈合不佳	5(1.21)
术腔少量出血	1(0.24)
远隔部位出血	1(0.24)

表1 患者显微血管减压术术后即刻和远期并发症汇总[例（%）]

并发症	即刻并发症	远期并发症
听力下降	36(8.70)	12(2.90)
耳聋	3(0.72)	3(0.72)
耳鸣	18(4.35)	5(1.21)
面瘫	26(6.28)	2(0.48)
头晕	45(10.87)	1(0.24)
一过性脑脊液瘘	16(3.86)
切口愈合不佳	5(1.21)
术腔少量出血	1(0.24)
远隔部位出血	1(0.24)

[1]	Haller S, Etienne L, Kovari E, et al. Imaging of neurovascular compression syndromes: trigeminal neuralgia, hemifacial spasm, vestibular paroxysmia, and glossopharyngeal neuralgia[J]. AJNR Am J Neuroradiol, 2016, 37(8): 1384-1392.
[2]	Jariyakosol S, Hirunwiwatkul P, Lerdlum S, et al. Prevalence and associated factors of neurovascular contact in patients with hemifacial spasm[J]. Asia Pac J Ophthalmol (Phila), 2015, 4(4): 212-215.
[3]	Lu AY, Yeung JT, Gerrard JL, et al. Hemifacial spasm and neurovascular compression[J]. ScientificWorldJournal, 2014, 2014: 349319.
[4]	于炎冰. MVD治疗颅神经疾病的现状与未来[J].中华脑科疾病与康复杂志(电子版), 2018, 8(1): 1-4.
[5]	El Refaee E, Langner S, Marx S, et al. Endoscope-assisted microvascular decompression for the management of hemifacial spasm caused by vertebrobasilar dolichoectasia[J]. World Neurosurg, 2019, 121: e566-e575.
[6]	Liu J, Yuan Y, Fang Y, et al. Microvascular decompression for atypical hemifacial spasm: lessons learned from a retrospective study of 12 cases[J]. J Neurosurg, 2016, 124(2): 397-402.
[7]	McLaughlin MR, Jannetta PJ, Clyde BL, et al. Microvascular decompression of cranial nerves: Lessons learned after 4400 operations[J]. J Neurosurg, 1999, 90(1): 1-8.
[8]	Li N, Zhao WG, Pu CH, et al. Hemifacial spasm associated with type 1 Chiari malformation: a retrospective study of 13 cases[J]. Neurosurg Rev, 2017, 40(2): 275-279.
[9]	Colpan ME, Sekerci Z. Chiari type I malformation presenting as hemifacial spasm: case report[J]. Neurosurgery, 2005, 57(2): E371; discussion E371.
[10]	郭田田，陈聚惠，苗重昌,等. 3.0T MR三维时间飞跃与三维稳态采集快速成像序列融合图像术前评估三叉神经、面神经与邻近血管关系[J].中国医学影像技术, 2018, 34(6): 836-840.
[11]	郑珂，何海青，杨爱春,等. 3D-TOF-MRA联合3D-FIESTA-C序列判断面肌痉挛责任血管的诊断价值[J].医学影像学杂志, 2019, 29(10): 1665-1668.
[12]	Lee SH, Park JS, Ahn YH. Bioglue-coated teflon sling technique in microvascular decompression for hemifacial spasm involving the vertebral artery[J]. J Korean Neurosurg Soc, 2016, 59(5): 505-511.
[13]	Swiatnicki W, Heleniak M, Komuński P. Hemifacial spasm caused by the cross-compression of the vertebral artery loop--a case-centered report of a stitched sling retraction technique[J]. Bull Soc Sci Med Grand Duche Luxemb, 2014, 151(3): 73-82.
[14]	Kim JP, Chung JC, Chang WS, et al. Outcomes of surgical treatment for hemifacial spasm associated with the vertebral artery: severity of compression, indentation, and color change[J]. Acta Neurochir (Wien), 2012, 154(3): 501-508.
[15]	Bigder MG, Kaufmann AM. Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations[J]. J Neurosurg, 2016, 124(1): 90-95.

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[11]	任鸿翔. 乙状窦后入路锁孔显微血管减压术治疗面肌痉挛[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(03): 188-192.
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Analysis and summary of the experience in patients with hemifacial spasm treated by microvascular decompression

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Analysis and summary of the experience in patients with hemifacial spasm treated by microvascular decompression