Samii Madjid, Günther Thomas, Iaconetta Giorgio, Muehling Michael, Vorkapic Peter, Samii Amir
Department of Neurosurgery, Nordstadt Medical Center, Klinikum Hannover, Hannover, Germany.
Neurosurgery. 2002 Apr;50(4):712-8; discussion 718-9. doi: 10.1097/00006123-200204000-00005.
The concept of neurovascular decompression for the treatment of hemifacial spasm is now widely accepted. In this study, we report our long-term results for 145 cases treated with this procedure.
The results of 145 microvascular decompressions to treat hemifacial spasm (performed between 1980 and 1998) among 143 patients (62.2% female patients and 37.8% male patients; mean age, 54.5 yr) are presented. The onset of symptoms was typical in 95.9% of cases and atypical in 4.1%. Platysma muscle involvement was observed for 24.5% of patients, with a higher incidence among female patients (74.3%). Patients were monitored with annual questionnaires. Twenty-six patients were lost to follow-up monitoring, and 117 are still undergoing follow-up monitoring, with an average period of 9.6 years (range, 1-17.6 yr).
At discharge, 69 patients (59%) were spasm-free and 48 patients (41%) experienced further spasm. At 6 months, the number of spasm-free patients had increased to 108 (92.3%), whereas only 9 patients (7.7%) complained of hemifacial spasm; 44 patients were spasm-free at an average time of 15 weeks. In follow-up examinations (average period, 9.4 yr), 106 patients were spasm-free. Seven patients experienced only temporary relief, with recurrence after 4.5 years. Two patients were spasm-free after 4 or 6 weeks, and the recurrence of spasm was observed 1 year later. Two patients were never completely spasm-free. Among the patients who did not undergo previous surgery elsewhere, only two experienced recurrence.
Deafness was the main postoperative complication (8.3%); most of those cases (66%) occurred before the routine use of intraoperative evoked potential monitoring. Analysis of our series demonstrates that this surgical procedure involves very low risk, is well tolerated by elderly patients, is associated with very low recurrence rates, and is a definitive treatment for more than 90% of cases.
神经血管减压术治疗面肌痉挛的概念现已被广泛接受。在本研究中，我们报告了采用该手术治疗的145例患者的长期结果。
呈现了143例患者（女性患者占62.2%，男性患者占37.8%；平均年龄54.5岁）在1980年至1998年间进行的145例微血管减压术治疗面肌痉挛的结果。95.9%的病例症状发作典型，4.1%不典型。24.5%的患者观察到颈阔肌受累，女性患者发生率更高（74.3%）。每年通过问卷调查对患者进行监测。26例患者失访，117例仍在接受随访监测，平均随访时间为9.6年（范围1 - 17.6年）。
出院时，69例患者（59%）痉挛消失，48例患者（41%）仍有痉挛。6个月时，痉挛消失的患者人数增至108例（92.3%），而仅有9例患者（7.7%）主诉面肌痉挛；44例患者平均在15周时痉挛消失。在随访检查（平均时间9.4年）中，106例患者痉挛消失。7例患者仅获得暂时缓解，4.5年后复发。2例患者在4周或6周后痉挛消失，1年后观察到痉挛复发。2例患者从未完全摆脱痉挛。在之前未在其他地方接受过手术的患者中，只有2例复发。
耳聋是主要的术后并发症（8.3%）；这些病例中的大多数（66%）发生在术中诱发电位监测常规使用之前。对我们系列病例的分析表明，该手术风险极低，老年患者耐受性良好，复发率极低，是90%以上病例的确定性治疗方法。
