摘要
目的分析原发性面肌痉挛(hemifacialspasm,HFS)患者首次行微血管减压术(microvascular decompression,MVD)无效的原因,评价短期内再手术的效果与安全性。方法首次行面神经MVD无效后在短期内再手术的25例患者,分析其手术过程、疗效和并发症情况。结果 2016年4月~2018年9月间共有25例HFS患者行短期内再手术,入院前病程5~240月(平均101.0±58.5月),两次MVD手术间隔时间21~216 h(中位时间48 h)。第一次手术失败的原因包括对面神经出脑干区(REZ)解剖欠清晰(60%)、遗漏潜在的神经血管压迫位点(24%)以及术中误判了异常肌反应的消失。再手术后,所有患者的临床症状均完全缓解,2例患者发生术侧Ⅱ级面瘫,2例患者发生术侧暂时性轻度听力下降。结论面神经MVD术后无效的原发性HFS患者可在短期内再手术。手术成功的关键在于充分显露面神经REZ区,结合异常肌反应监测以避免遗漏神经血管压迫位点。
Objective To analyze the causes of ineffective microvascular decompression(MVD) for patients with primary hemifacial spasm(HFS), and to evaluate the efficacy and safety of short-term reoperation. Methods Twenty-five primary HFS patients who underwent a second MVD shortly after failure of the first one were collected, their operation process, outcomes and complications were analyzed. Results Twenty-five patients underwent short-term reoperation after first MVD between April 2016 to September 2018. The course of HFS before admission ranged 5~240 months(mean(101.0±58.5) months). The interval between two surgeries was 21~216 h(median 48 hours). The causes of failure of first MVD included unclear anatomy(60%) of facial nerve root exit zone(REZ), missing potential neurovascular compression(24%) and misjudging the negative for abnormal muscle response(AMR). All patients experienced complete relief after reoperation, 2 patients suffered grade Ⅱ facial palsy, and 2 patients noted mild temporary hearing loss on the operation side. Conclusion Short-term reoperation could be an option for primary HFS patients after an ineffective MVD. The keys to a successful MVD are fully reveal of REZ and making sure no neurovascular compression is missed with AMR monitoring.
作者
孙秋阳
张文博
闵令钊
陶帮宝
李宾
王晓强
SUN Qiu-yang;ZHANG Wen-bo;MIN Ling-zhao;TAO Bang-bao;LI Bin;WANG Xiao-qiang(Department of Neurosurgery,XinHua Hospital,Shanghai Jiao Tong University School of Medi-cine,Shanghai 200092,China)
出处
《哈尔滨医科大学学报》
CAS
2019年第5期555-557,共3页
Journal of Harbin Medical University
关键词
面肌痉挛
微血管减压术
再手术
面神经出脑干区
异常肌反应
hemifacial spasm
microvascular decompression
reoperation
facial nerve exit zone
abnormal muscle response
