[1]李东冉,姚安会,任豪,等.绒球下入路微血管减压术治疗面肌痉挛疗效分析[J].中国临床神经外科杂志,2023,28(01):18-21.[doi:10.13798/j.issn.1009-153X.2023.01.006]
　LI Dong-ran,YAO An-hui,REN Hao,et al.Clinical efficacy and safety of microvascular decom-pression through infrafloccular approach for patients with hemifacial spasm[J].,2023,28(01):18-21.[doi:10.13798/j.issn.1009-153X.2023.01.006]
点击复制

绒球下入路微血管减压术治疗面肌痉挛疗效分析()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
28
期数:
2023年01期
页码:
18-21
栏目:
论著
出版日期:
2023-01-25

文章信息/Info

Title:
Clinical efficacy and safety of microvascular decom-pression through infrafloccular approach for patients with hemifacial spasm
文章编号:
1009-153X（2023）01-0018-04
作者:
李东冉; 姚安会; 任豪; 赖生龙; 邢亚洲; 李海洋; 梁庆华; 王本瀚
453003河南新乡，新乡医学院（李东冉、任豪）；450007郑州，中国人民解放军联勤保障部队第988医院神经外科（李东冉、任豪、姚安会、王本瀚）；450003郑州，河南省人民医院郑州大学人民医院神经外科（李东冉、赖生龙、邢亚洲、李海洋、梁庆华）
Author(s):
LI Dong-ran1; 2; 3;  YAO An-hui2;  REN Hao1; 2;  LAI Sheng-long3;  XING Ya-zhou3;  LI Hai-yang3;  LIANG Qing-hua3;  WANG Ben-han2
1.Xinxiang Medical College, Xinxiang 453003, China; 2.Department of Neurosurgery, The 988th Hospital of Joint Logistics Support Force, PLA, Zhengzhou 450007, China; 3.Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou 450003, China
关键词:
面肌痉挛; 显微血管减压术; 绒球下入路; 疗效; 安全性
Keywords:
Hemifacial spasm;  Microvascular decompression;  Infrafloccular approach;  Efficacy;  Safety
分类号:
R745.1+2;R651.1+1
DOI:
10.13798/j.issn.1009-153X.2023.01.006
文献标志码:
A
摘要:
目的 探讨绒球下入路微血管减压术（MVD）治疗面肌痉挛（HFS）的安全性和有效性。方法 回顾性分析2020年7月至2021年6月采用绒球下入路MVD治疗的233例HFS的临床资料。结果 术中发现单一血管压迫166例（71.2%），其中小脑前下动脉142例；多支血管压迫67例（28.8%），其中椎动脉参与53例。术后1、3、6、12个月有效率分别为95.3%、94.8%、95.3%、94.8%。术后1年复发率为1.7%。术后发生并发症26例（11.2%），其中无菌性脑膜炎10例，脑脊液鼻漏3例，迟发性面瘫6例，后组颅神经麻痹4例，听力损伤2例，小脑梗死1例。结论 绒球下入路MVD治疗HFS是一种安全的、有效的手术方法，可充分显露面神经根出脑干区，同时减少对小脑的牵拉，降低听力损伤风险。
Abstract:
Objective To investigate the efficacy and safety of microvascular decompression (MVD) through an infrafloccular approach for patients with hemifacial spasms (HFS). Methods The clinical data of 233 patients with HFS who underwent MVD through an infrafloccular approach from July 2020 to June 2021 were analyzed retrospectively. Results During the operation, single vessel compression was found in 166 patients (71.2%) and multiple vessel compression in 67 patients (28.8%). The effective rate was 95.3%, 94.8%, 95.3%, and 94.8% at 1, 3, 6, and 12 months after the operation, respectively. The recurrence rate was 1.7% one year after surgery. Postoperative complications occurred in 26 patients (11.2%), of whom 10 were aseptic meningitis, 3 cerebrospinal fluid rhinorrhea, 6 delayed facial paralysis, 4 the cranial nerve palsy, 2 hearing damage, and 1 cerebellar infarction. Conclusions MVD through an infrafloccular approach is a safe and effective surgical method for patients with HFS, which can fully expose the root exit zone of the facial nerve, reduce retract on the cerebellum, and the risk of hearing loss.

参考文献/References:

[1]Wang A, Jankovic J. Hemifacial spasm: clinical findings and treatment [J]. Muscle Nerve, 1998, 21(12): 1740-1747.
[2]Wang C, Zhu X, Xia L, et al. Botulinum toxin A improves psychological distress in patients with hemifacial spasm [J]. Acta Neurologica Belgica, 2022, 122(1): 43-49.
[3]Gardner WJ. Concerning the mechanism of trigeminal neuralgia and hemifacial spasm [J]. J Neurosurg, 1962, 19(11): 947-958.
[4]Sindou M, Mercier P. Microvascular decompression for hemifacial spasm: surgical techniques and intraoperative monitoring [J]. Neurochirurgie, 2018, 64(2): 133-143.
[5]杜　浩，黄　河，宋　健，等. 面肌痉挛微血管减压术后并发症的相关危险因素分析[J]. 中国临床神经外科杂志，2016，21（5）：267-269.
[6]Hitotsumatsu T, Matsushima T, Inoue T. Microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia: three surgical approach variations: technical note [J]. Neurosurgery, 2003, 53(6): 1436-1443.
[7]Nakahara Y, Matsushima T, Hiraishi T, et al. Importance of awareness of the rhomboid lip in microvascular decompression surgery for hemifacial spasm [J]. J Neurosurg, 2013, 119(4): 1038-1042.
[8]Park HS, Chang DK, Han YM. Infranuchal infrafloccular approach to the more vulnerable segments of the facial nerve in microvascular decompressions for the hemifacial spasm [J]. J Korean Neurosurg Soc, 2009, 46(4): 340-345.
[9]Amagasaki K, Watanabe S, Naemura K, et al. Microvascular decompression for hemifacial spasm: how can we protect auditory function [J]. Br J Neurosurg, 2015, 29(3): 347-352.
[10]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脑神经疾患协作组. 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.
[11]Campos-Benitez M, Kaufmann AM. Neurovascular compression findings in hemifacial spasm [J]. J Neurosurg, 2008, 109(3): 416-420.
[12]Liang Q, Shi X, Wang Y, et al. Microvascular decompression for hemifacial spasm: technical notes on pontomedullary sulcus decompression [J]. Acta Neurochir （Wien), 2012, 154(9): 1621-1626.
[13]Dannenbaum M, Lega BC, Suki D, et al. Microvascular decompression for hemifacial spasm: long-term results from 114 operations performed without neurophysiological monitoring [J]. J Neurosurg, 2008, 109(3): 410-415.
[14]Hyun SJ, Kong DS, Park K. Microvascular decompression for treating hemifacial spasm: lessons learned from a prospective study of 1,174 operations [J]. Neurosurg Rev, 2010, 33(3): 325-334.
[15]Lee JM, Park HR, Choi YD, et al. Delayed facial palsy after microvascular decompression for hemifacial spasm: friend or foe [J]. J Neurosurg, 2018, 129(2): 299-307.
[16]Liu LX, Zhang CW, Ren PW, et al. Prognosis research of delayed facial palsy after microvascular decompression for hemifacial spasm [J]. Acta Neurochir (Wien), 2016, 158(2): 379-385.
[17]Lee MH, Lee HS, Jee TK, et al. Cerebellar retraction and hearing loss after microvascular decompression for hemifacial spasm [J]. Acta Neurochir (Wien), 2015, 157(2): 337-343.
[18]Thirumala P, Frederickson AM, Balzer J, et al. Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm [J]. J Neurosurg, 2015, 123(4): 1059-1064.
[19]Joo BE, Park SK, Cho KR, et al. Real-time intraoperative monitoring of brainstem auditory evoked potentials during microvascular decompression for hemifacial spasm [J]. J Neurosurg, 2016, 125(5): 1061-1067.
[20]Miller LE, Miller VM. Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm: a systematic review [J]. Br J Neurosurg, 2012, 26(4): 438-444.
[21]Sindou M, Keravel Y. Neurosurgical treatment of primary hemifacial spasm with microvascular decompression [J]. Neurochirurgie, 2009, 55(2): 236-247.
[22]Jo KW, Kong DS, Park K. Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure [J]. Neurosurg Rev, 2013, 36(2): 297-302.
[23]Liu MX, Xia L, Zhong J, et al. What should we do for those hemifacial spasm patients without efficacy following microvascular decompression: expectation of delayed relief or early reoperation [J]. World Neurosurg, 2018, 110: e897-e900.
[24]Kim M, Cho KR, Park SK, et al. Prognostic value of lateral spread response recorded 1 month after microvascular decompression for the treatment of hemifacial spasm [J]. Neurosurgery, 2022, 91(1): 159-166.

相似文献/References:

[1]杜　浩　黄　河　宋　健　何远志　孙荣辉　丁慧超　姚　顺　徐国政.面肌痉挛微血管减压术后并发症的相关危险因素分析[J].中国临床神经外科杂志,2016,(05):267.[doi:10.13798/j.issn.1009-153X.2016.05.004]
　DU Hao,HUANG He,SONG Jian,et al.Analysis of risk factors related to complications after microvascular decompression in patients with hemifacial spasm[J].,2016,(01):267.[doi:10.13798/j.issn.1009-153X.2016.05.004]
[2]申彦杰　宋　健　成文平　程东亮.微血管减压术治疗面肌痉挛57例[J].中国临床神经外科杂志,2016,(04):238.[doi:10.13798/j.issn.1009-153X.2016.04.016]
[3]黄　进　吴祥奎　张岩松　邵君飞.肌电图监测在面肌痉挛微血管减压术中的应用[J].中国临床神经外科杂志,2016,(03):164.[doi:10.13798/j.issn.1009-153X.2016.03.011]
　HUANG Jin,WU Xiang-kui,ZHANG Yan-song,et al.Application of EMG monitoring to microvascular decompression for hemifacial spasm[J].,2016,(01):164.[doi:10.13798/j.issn.1009-153X.2016.03.011]
[4]曾　冉　王飞红　袁邦清　杨　光　苏同刚.微血管减压术治疗面肌痉挛疗效分析[J].中国临床神经外科杂志,2016,(03):175.[doi:10.13798/j.issn.1009-153X.2016.03.016]
[5]向兴刚　张永辉　李大志　昝向阳　于晓晨　蔡　宁　赵　永　林　琳.神经内镜辅助微血管减压术治疗面肌痉挛疗效分析[J].中国临床神经外科杂志,2015,(10):624.[doi:10.13798/j.issn.1009-153X.2015.10.015]
[6]卫永旭　杨文磊　赵卫国　李　宁　蔡　瑜　濮春华　吴哲褒.肌松药对面肌痉挛微血管减压术中电生理监测的影响[J].中国临床神经外科杂志,2015,(09):526.[doi:10.13798/j.issn.1009-153X.2015.09.005]
　WEI Yong-xu,YANG Wen-lei,ZHAO Wei-guo,et al.Effect of muscle relaxants on lateral spread responses during microvascular decompression for hemifacial spasm[J].,2015,(01):526.[doi:10.13798/j.issn.1009-153X.2015.09.005]
[7]耿　飞.枕下乙状窦后入路微血管减压治疗面肌痉挛的并发症及处理[J].中国临床神经外科杂志,2015,(03):168.[doi:10.13798/j.issn.1009-153X.2015.03.014]
[8]贾　力　傅先明　姜晓峰　牛朝诗　邓大丽　何金超　李仲森　汪业汉.神经电生理监测异常肌反应在面肌痉挛术中的作用[J].中国临床神经外科杂志,2015,(05):262.[doi:10.13798/j.issn.1009-153X.2015.05.002]
　JIA Li,FU Xian-ming,JIANG Xiao-feng,et al.Use of intraoperative electrophysiological monitoring of abnormal muscle response in surgery for hemifacial spasm[J].,2015,(01):262.[doi:10.13798/j.issn.1009-153X.2015.05.002]
[9]余海林　宋业纯　王晓松.单纯表现为面肌痉挛的桥小脑角区胶样囊肿1例[J].中国临床神经外科杂志,2017,(03):138.[doi:10.13798/j.issn.1009-153X.2017.03.003]
[10]王　宁　王　林　陈国强　黄乙洋　焦永辉　郭宇鹏　王晓松.以三叉神经痛和/或面肌痉挛起病的桥小脑角区肿瘤的手术治疗[J].中国临床神经外科杂志,2017,(08):549.[doi:10.13798/j.issn.1009-153X.2017.08.009]
　WANG Ning,WANG Lin,CHEN Guo-qiang,et al.Microsurgery via suboccipital retrosigmoid approach for cerebellopontine angle tumors with onset of trigeminal neuralgia and hemifacial spasm[J].,2017,(01):549.[doi:10.13798/j.issn.1009-153X.2017.08.009]
[11]王文雄　成　睿 综述　张刚利 审校.弥散张量成像辅助面肌痉挛治疗研究进展[J].中国临床神经外科杂志,2020,(05):331.[doi:10.13798/j.issn.1009-153X.2020.05.026]
[12]王晶,种玉龙,戴宇翔,等.双侧椎动脉相关面肌痉挛的手术疗效分析[J].中国临床神经外科杂志,2022,27(10):805.[doi:10.13798/j.issn.1009-153X.2022.10.002]
　WANG Jing,CHONG Yu-long,DAI Yu-xiang,et al.Surgical outcomes of hemifacial spasm associated with bilateral vertebral artery compression[J].,2022,27(01):805.[doi:10.13798/j.issn.1009-153X.2022.10.002]
[13]张婧,宋启民,程彦昊,等.多模式神经电生理监测在面肌痉挛MVD中的应用[J].中国临床神经外科杂志,2024,29(01):19.[doi:10.13798/j.issn.1009-153X.2024.01.006]
　ZHANG Jing,SONG Qi-min,CHENG Yan-hao,et al.Application of multimodal neuroelectrophysiological monitoring in microvascular decompression for patients with hemifacial spasm[J].,2024,29(01):19.[doi:10.13798/j.issn.1009-153X.2024.01.006]
[14]任坚锋,赵永斌,田杨,等.不同刺激强度下的异常肌反应对面肌痉挛显微血管减压术中操作的指导意义[J].中国临床神经外科杂志,2023,28(10):632.[doi:10.13798/j.issn.1009-153X.2023.10.007]
　REN Jian-feng,ZHAO Yong-bin,TIAN Yang,et al.Significance of abnormal muscle response under different stimulation intensity during microvascular decompression for patients with primary facial spasm[J].,2023,28(01):632.[doi:10.13798/j.issn.1009-153X.2023.10.007]

备注/Memo

备注/Memo:
（2022-11-14收稿，2023-01-15修回）
通讯作者：梁庆华，E-mail：qzqhuayuan@163.com
王本瀚，E-mail：wangbenhan@sina.com
更新日期/Last Update: 2022-02-28