Qi Song-tao, Zhu Wei-lin, Zhang Xi-an
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2007 Dec;27(12):1896-900.
To compare the efficacy and micromanipulation techniques of microvascular decompression with whole-range encirclement method and the conventional method in 65 cases of hemifacial spasm.
The data of 65 surgically managed cases of hemifacial spasm were retrospectively analyzed for intraoperative findings, surgical techniques, and the patients' outcomes. Microvascular decompression with the conventional approach was performed in 30 patients (group A), and whole-range encircling method was used in the other 35 patients (group B). The patients were also divided into group C (below 40 years, n=27) and group D (above 40 years, n=38) according to the onset age of the symptom.
In these patients, 4 patterns of facial nerve compression were identified: simple contact, contact and indentation, adhesion and encasement, and unidentified offending vessels. The offending vessels included the arteries, veins, and vascular loops. In most patients in group C, the arachnoid membrane around the facial nerve thickened and encircled the offending ve;ssel; in group D, the characteristic changes of the vasculature occurred in the offending artery, resulting in its displacement. In groups A and B, the overall efficacy rate was 80% and 97.1%, with recurrence rates of 13.3% and 2.9%, respectively. The major permanent complications in group A included hearing impairment (10.0%) and ataxia (6.7%), whose incidences in group B were 2.9% and 2.9%, respectively.
Microvascular decompression with whole-range encircling method is a safe approach associated with high cure rate, in which careful avoidance of injuries to the cranial nerves and the penetrating vessels from the root entry/exit zone and the pons ensure good outcome and minimize the likeliness of recurrence and complications.
比较微血管减压术全范围包绕法与传统方法治疗65例面肌痉挛的疗效及显微操作技术。
回顾性分析65例接受手术治疗的面肌痉挛患者的术中发现、手术技术及患者预后。30例患者采用传统方法进行微血管减压术（A组），另外35例患者采用全范围包绕法（B组）。根据症状发作年龄，患者还分为C组（40岁以下，n = 27）和D组（40岁以上，n = 38）。
在这些患者中，确定了4种面神经受压模式：单纯接触、接触伴压迹、粘连和包裹以及不明责任血管。责任血管包括动脉、静脉和血管袢。C组大多数患者面神经周围蛛网膜增厚并包绕责任静脉；D组责任动脉出现血管系统特征性改变，导致其移位。A组和B组的总有效率分别为80%和97.1%，复发率分别为13.3%和2.9%。A组主要的永久性并发症包括听力障碍（10.0%）和共济失调（6.7%），B组的发生率分别为2.9%和2.9%。
微血管减压术全范围包绕法是一种安全的方法，治愈率高，其中小心避免损伤神经根入/出区和脑桥的颅神经及穿通血管可确保良好预后并最大限度降低复发和并发症的可能性。
