Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, The Cranial Nerve Disease Center of Shanghai, 1665 KongJiang Road, Shanghai 200092, China.
J Clin Neurosci. 2012 Mar;19(3):375-9. doi: 10.1016/j.jocn.2011.04.046. Epub 2012 Jan 25.
Although microvascular decompression (MVD) is accepted as an effective therapy for hemifacial spasm (HFS), some operations fail. While performing MVD, many surgeons focus on the large arteries but ignore the arterioles. Failure to identify involved arterioles may account for unsuccessful MVD. We aimed to refine the MVD surgery and improve post-operative outcomes by proper management of involved arterioles. Clinical data were collected from 69 consecutive patients who underwent MVD. Intraoperative electromyography (EMG) was employed for each MVD. Each operation was reviewed with a focus on the involved arterioles. All patients were followed up for between nine and 12 months. An abnormal muscle response (AMR) wave was identified by EMG in all patients before decompression, but vanished in most patients as soon as the involved arteries were removed from the cranial nerve (CN). However, in nine of 69 patients, the AMR did not immediately disappear. Further dissection and exploration of the entire CN VII identified an arteriole in contact with, or in some patients embedded in, the nerve. Once the arteriole was isolated from the CN, the AMR disappeared. After surgery, spasms ceased in all patients and no recurrence was found up to the one-year follow-up. To achieve a positive post-operative outcome, exploration of the entire CN VII is necessary, with a focus on the small arterioles. AMR can be a good adjuvant to identify the involved arterioles.
虽然微血管减压术（MVD）被认为是治疗面肌痉挛（HFS）的有效方法，但有些手术还是会失败。在进行 MVD 时，许多外科医生关注大动脉而忽略了小动脉。未能识别出受累的小动脉可能是 MVD 手术不成功的原因。我们旨在通过适当处理受累的小动脉来改进 MVD 手术并改善术后结果。
从 69 例连续接受 MVD 的患者中收集了临床数据。对每位 MVD 患者均进行了术中肌电图（EMG）检查。对每例手术进行了回顾，重点是受累的小动脉。所有患者均随访 9-12 个月。在减压前，所有患者的 EMG 均识别出异常肌肉反应（AMR）波，但在大多数患者中，一旦将受累动脉从颅神经（CN）中取出，该波就消失了。然而，在 69 例患者中有 9 例，AMR 并未立即消失。进一步对整个 CN VII 进行解剖和探查，发现一条小动脉与神经接触，或在某些患者中嵌入神经。一旦将小动脉与 CN 分离，AMR 就消失了。
手术后，所有患者的痉挛均停止，在一年的随访中未发现复发。为了获得良好的术后效果，有必要对整个 CN VII 进行探查，重点是小动脉。AMR 可以作为识别受累小动脉的良好辅助手段。
