Department of Neurological Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Neurosurg Rev. 2013 Oct;36(4):637-43; discussion 643-4. doi: 10.1007/s10143-013-0480-z. Epub 2013 Jun 10.
The objective of this study is to investigate late repeat microvascular decompression (MVD) with persistent or recurrent hemifacial spasm (HFS) and to compare the clinical characteristics, intraoperative findings, complications, and outcomes with first MVD. We analyzed MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000 and December 31, 2007. Thirty-three patients who underwent late redo MVDs were classified as group I and 243 patients who underwent their first MVD as group II. Clinical data were collected to analyze the difference between the two groups. The mean follow-up period was 54.48 months (range, 9-102 months). There is no significant difference in preoperative clinical characteristics (gender, age, side of MVD, botox usage, facial weakness) between the two groups. In present study, we found a vein as the offending vessel in significantly more number of patients who underwent repeat MVD as compared to first MVD (P = 0.02). The lateral spread response disappeared in 66% of patients during repeat MVDs, which is not different from those undergoing their first MVD. No difference in the relief rate was found during the immediate postoperative, discharge, or follow-up stages between repeat and first MVD. Moreover, no difference was found in the incidence of complications between repeat MVD and first MVD. Late repeat MVD for HFS is an effective and safe procedure. No specific preoperative clinical characteristics were identified in patients with repeat MVD. Intraoperative monitoring with lateral spread response (LSR) is an effective tool to evaluate adequate decompression. In patients with persistent LSR at the end of the procedure, facial nerve compression from a vein should be examined. We believe that it is important to undergo a repeat MVD for failed HFS relief irrespective of the timing of the operation.
本研究旨在探讨持续性或复发性面肌痉挛（HFS）患者的晚期重复微血管减压术（MVD），并将其与初次 MVD 的临床特征、术中发现、并发症和结果进行比较。我们分析了 2000 年 1 月 1 日至 2007 年 12 月 31 日期间在匹兹堡大学医学中心进行的 MVD。33 例接受晚期重复 MVD 的患者被分为 I 组，243 例接受初次 MVD 的患者被分为 II 组。收集临床资料以分析两组之间的差异。平均随访时间为 54.48 个月（范围，9-102 个月）。两组患者术前临床特征（性别、年龄、MVD 侧、肉毒杆菌使用、面部无力）无显著差异。在本研究中，我们发现与初次 MVD 相比，接受重复 MVD 的患者中，静脉作为致病血管的比例显著增加（P=0.02）。在重复 MVD 过程中，66%的患者外侧扩散反应消失，与初次 MVD 无差异。重复 MVD 和初次 MVD 在即刻、出院和随访阶段的缓解率无差异。此外，重复 MVD 和初次 MVD 的并发症发生率也无差异。晚期重复 MVD 治疗 HFS 是一种有效且安全的方法。在接受重复 MVD 的患者中，没有发现特定的术前临床特征。术中监测外侧扩散反应（LSR）是评估充分减压的有效工具。对于术中 LSR 持续存在的患者，应检查面神经受压是否来自静脉。我们认为，对于未能缓解的 HFS 患者，无论手术时间如何，重复进行 MVD 都很重要。
