Badr-El-Dine M, El-Garem H F, Talaat A M, Magnan J
Department of Otolaryngology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Otol Neurotol. 2002 Mar;23(2):122-8. doi: 10.1097/00129492-200203000-00002.
The aim of this study was to assess the use of endoscopy in minimally invasive surgery of the cerebellopontine angle in cases of hemifacial spasm.
Eighty patients with hemifacial spasm underwent endoscopically assisted microvascular decompression between October 1992 and October 1998, at the Ear, Nose, and Throat Department of Nord Hospital in Marseille, France. The microvascular decompression was performed via a minimally invasive retrosigmoid approach. The cerebellopontine angle was then explored by a 30-degree endoscope to visualize the root exit zone of the facial nerve and the precise location of the site of the conflict. Microvascular decompression was performed under the microscope. If the site was an artery, a Teflon sponge was inserted; if the site was a vein, it was coagulated and then dissected away from the facial nerve.
In 80 patients seen regularly for at least 1 year of follow-up, and including patients operated on once or twice, the procedure was successful in 92.5% of patients, brought about improvement in 3.75% (96.25% success plus improvement), and failed in 3.75%. In relation to the type of conflict, success or improvement was experienced by 90.7% of patients with simple conflicts, 86.2% of patients with multiple conflicts, and 87.5% of patients with nutcracker conflicts. No major postoperative complication or mortality occurred in this series. No facial paresis or paralysis occurred immediately postoperatively. Three patients (3.25%) experienced delayed facial palsy. Postoperative cerebrospinal fluid leak occurred in 2 patients (2.5%) and was treated surgically.
The principle of minimally invasive surgery in the cerebellopontine angle is gaining universal acceptance. The use of endoscopy in microvascular decompression for hemifacial spasm has helped tremendously in improving the results. In this study, the use of the endoscope enabled the authors to identify the site of the conflict in all cases, and to confirm the position of the Teflon sponge before closure.
本研究旨在评估在半面痉挛病例中，内镜在桥小脑角微创手术中的应用。
1992年10月至1998年10月期间，法国马赛诺德医院耳鼻喉科对80例半面痉挛患者进行了内镜辅助微血管减压术。微血管减压术通过微创乙状窦后入路进行。然后用30度内镜探查桥小脑角，以观察面神经的根出区和冲突部位的精确位置。微血管减压术在显微镜下进行。如果冲突部位是动脉，则插入一块特氟龙海绵；如果是静脉，则进行凝固，然后从面神经上分离。
在80例接受了至少1年定期随访的患者中，包括接受过一次或两次手术的患者，该手术在92.5%的患者中成功，3.75%的患者病情得到改善（96.25%成功加改善），3.75%的患者手术失败。就冲突类型而言，单纯冲突患者中有90.7%获得成功或病情改善，多重冲突患者中有86.2%，胡桃夹样冲突患者中有87.5%。本系列未发生重大术后并发症或死亡。术后未立即出现面部轻瘫或面瘫。3例患者（3.25%）出现迟发性面瘫。2例患者（2.5%）发生术后脑脊液漏，并接受了手术治疗。
桥小脑角微创手术原则正得到广泛认可。内镜在半面痉挛微血管减压术中的应用极大地改善了手术效果。在本研究中，内镜的使用使作者能够在所有病例中识别冲突部位，并在关闭前确认特氟龙海绵的位置。
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