Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, The Cranial Nerve Disease Center of Shanghai, 1665 KongJiang Rd., Shanghai 200092, China.
Int J Surg. 2011;9(3):254-7. doi: 10.1016/j.ijsu.2010.12.004. Epub 2010 Dec 22.
The root exit zone (REZ) of the seventh cranial nerve has been the target of microvascular decompression surgery (MVD) while searching the neurovascular conflict for treatment of hemifacial spasm for long time. Recently, increasing cases regarding the offending vessel beyond the REZ have been reported. To verify whether a thorough dissection of the nerve may give rise to a better postoperative result without enhancing complications, we conducted a parallel investigation.
112 Connective entire-nerve-exposed MVDs were performed and compared to 186 REZ-exposed MVDs performed by the same group of surgeons in 2009. The surgical findings, postoperative outcomes and complications as well as microscopic operating time were examined.
Immediately after the surgery, the outcomes were excellent in 98.2%, good in 1.8% and poor in 0% in the entire-nerve-exposed group, compared to excellent in 92.5%, good in 1.6% and poor in 5.9% in the REZ-exposed group. The difference of outcomes between the two groups were statistically significant (χ(2)=4.6845, P=0.0304), but not the complications and microscopic operating time. Nine of the 11 poor-outcome patients from the REZ-exposed group were then reoperated on within a few days, and their symptoms disappeared in eight patients. The main reason for the failed surgeries was that the offending vessels beyond REZ were missed.
These findings suggested that the entire-root-decompression technique is recommended while performing MVDs in patients with hemifacial spasm.
第七颅神经的神经根出口区（REZ）一直是微血管减压手术（MVD）的目标，长期以来一直在寻找治疗面肌痉挛的神经血管冲突。最近，越来越多的病例报告显示，责任血管超出了 REZ。为了验证是否彻底解剖神经可以带来更好的术后效果而不增加并发症，我们进行了一项平行研究。
对 112 例连续神经暴露 MVD 与同一组外科医生在 2009 年进行的 186 例 REZ 暴露 MVD 进行了比较。检查了手术发现、术后结果和并发症以及显微镜操作时间。
在神经暴露组中，手术后即刻结果为优者占 98.2%，良者占 1.8%，差者占 0%，而在 REZ 暴露组中，优者占 92.5%，良者占 1.6%，差者占 5.9%。两组间的结果差异有统计学意义（χ(2)=4.6845，P=0.0304），但并发症和显微镜操作时间无差异。REZ 暴露组中 9 例预后差的患者在几天内再次手术，其中 8 例症状消失。手术失败的主要原因是责任血管超出 REZ 而被遗漏。
这些发现表明，在进行面肌痉挛的 MVD 时，推荐使用整个神经根减压技术。
