摘要
目的:探讨治疗面肌痉挛的功能性手术方式,讨论如何提高手术成功率、增加手术安全性及减少并发症等有关微创的相关问题。方法:回顾性分析286例面肌痉挛患者的临床资料,采用经内镜下耳后小切口乙状窦后入路小脑脑桥角血管减压术进行治疗。结果:术中发现责任血管285例(99.7%),其中为小脑下前动脉264例,基底动脉21例,用Teflon隔离;蛛网膜粘连但未发现责任血管1例(0.3%)。术后面肌痉挛立即消失。术后1周面神经功能1/6级196例,2/6级62例,3/6级23例,4/6级4例,5/6级1例;术后半年面神经功能1/6级274例,2/6级10例,3/6级2例。术后1个月听力无明显变化238例,下降<20dB35例,20～<50dB10例,≥50dB3例。出现脑脊液耳鼻漏2例,均治愈。无其他并发症及死亡患者。随访1～4年,面肌痉挛复发3例(1.0%),1例再次手术治愈。结论:内镜下耳后小切口乙状窦后入路小脑脑桥角血管减压术是治疗面肌痉挛的理想术式。内镜应用提高了责任血管的发现率,有助于脑组织和神经功能的保护。
Objective： To investigate the value of the endoscopy in the operation of microvascular decompression（MVD） for the hemifacial spasm by approach of postauricular suboceipital to the cerehellopontine angle（CPA） with posterior auricular small incision. Method：Two hundred and eighty-six cases of hemifacial spasm had received the operation of MVD with endoscopy by approach of postauricular suboccipital to the CPA. Result： Responsible blood vessels were found in 285 cases（99.7 percent） , including 264 cases of anterior inferior cerebellar artery, 21 cases of basilar artery. The root entry zone of the facial nerve were completely decompressed with Teflon. There is no responsible blood vessels but adhesion in 1 cases（0.3 percent）. After surgery, hemifacial spasm immediately disappeared. House-Brackmann（1985） grading system was used to evaluated the recovery of facial nerve function. After 1 week of operation 196 casesr facial nerve function are stage 1/6,62 cases＇ are stage 2/6, 23 cases＇ are stage 3/6, 4 cases＇ are stage 4/6, 1 caseJ is stage 5/6. And after Six months of operation,274 cases＇ are stage 1/6, 10 cases＇ are stage 2/6, 2 cases＇ are stage 3/6. After 1 month of operation there is no significant change of hearing in 238, there are 35 cases of hearing loss less than 20 dB, 10 cases of hearing loss more than 20 dB, But less than 50 dB, 3 cases of hearing loss more than 50 dB. Ear-nose cerebrospinal fluid leakage occurred in 2 cases are cured. During 1 year to 4 years following-up, only 3（1.0 percent） preliminary suffered relapse,among which 1 case was cured By the secondary operation. The long term cure rate was 99.3 percent without occurrence of serious complications such as death. Conclusion：The microneurosurgery of MVD for the treatment of hemifacial spasm is an ideally functional and etiotropic operation. It is useful.not only to discover the responsible blood vessels which are regarded as those pressing the root entry zone of facial nerve,but also to protect the function of the brain tissue and nerves as well. It is a safe, minimally invasive and efficient operation. To avoid the complications,enough knowledge of the craniotopography and skilled technique of endoscopic operation are primary.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2009年第4期145-148,共4页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
面肌痉挛
血管减压术
内镜术
hemifacial spasm
microvascular decompression
endoscopy
