Wu Guangyong, Ouyang Jia, Zhang Zhiyu, Liu Ruen
Department of Neurosurgery, Peking University People's Hospital, Beijing, People's Republic of China.
Department of Neurosurgery, Peking University People's Hospital, Beijing, People's Republic of China.
World Neurosurg. 2018 Feb;110:e560-e566. doi: 10.1016/j.wneu.2017.11.050. Epub 2017 Nov 20.
Unilateral masticatory muscle spasm is a rare disease without a generally accepted and efficacious treatment plan.
We sought to compare the effects of different surgical treatments on unilateral masticatory muscle spasm.
A retrospective analysis of the surgical treatment and effects of 10 cases of unilateral masticatory muscle spasm occurred between February 2010 and September 2016. Three cases underwent complete amputation of the trigeminal motor branch, 3 cases underwent partial amputation of the trigeminal motor branch, and 4 cases received only vascular decompression. All patients were followed up by telephone interview after surgery.
In the simple vascular decompression group, 3 cases were cured and 1 was cured after a delay. Of these 3 cases, 1 case became aggravated 2 years after the operation, 1 case became aggravated 5 years after the operation, and 1 case showed no change during the follow-up period. In the partial amputation group, 2 cases were cured and 1 case was alleviated. Of the 2 patients who were cured, 1 suffered recurrence 2 years later, while the other case showed no recurrence during the follow-up period. In the complete amputation group, 1 case was cured with a delay and 2 cases were cured immediately with no recurrence during the follow-up. Mild atrophy of the temporal muscle occurred gradually with no restriction of the mouth opening in 2 cases.
Complete amputation of the trigeminal nerve did achieve better effects than pure microvascular decompression and partial amputation of the trigeminal motor branch, but it may lead to mild temporal muscle atrophy.
单侧咀嚼肌痉挛是一种罕见疾病,尚无普遍接受且有效的治疗方案。
我们旨在比较不同手术治疗对单侧咀嚼肌痉挛的效果。
回顾性分析2010年2月至2016年9月间发生的10例单侧咀嚼肌痉挛患者的手术治疗及效果。3例行三叉神经运动支完全切断术,3例行三叉神经运动支部分切断术,4例仅行血管减压术。所有患者术后通过电话随访。
单纯血管减压组,3例治愈,1例延迟治愈。这3例中,1例术后2年病情加重,1例术后5年病情加重,1例随访期间无变化。部分切断组,2例治愈,1例缓解。治愈的2例中,1例2年后复发,另1例随访期间未复发。完全切断组,1例延迟治愈,2例立即治愈,随访期间无复发。2例逐渐出现颞肌轻度萎缩,张口无受限。
三叉神经完全切断术的效果确实优于单纯微血管减压术和三叉神经运动支部分切断术,但可能导致颞肌轻度萎缩。