Xu Xiao-Li, Zhen Xue-Ke, Yuan Yue, Liu Hong-Ju, Liu Jiang, Xu Jun, Li Xiu-Bin, Zhang Li, Yu Yan-Bing
Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China.
Organ Transplantation Institute, The 309th Hospital of Chinese People's Liberation Army, Haidian District, Beijing, People's Republic of China.
World Neurosurg. 2018 Feb;110:e989-e997. doi: 10.1016/j.wneu.2017.11.144. Epub 2017 Dec 2.
Although repeat microvascular decompression (MVD) for hemifacial spasm (HFS) in patients with failed prior MVD is potentially curative, little is known about the long-term results of repeat MVD. We aimed to evaluate the long-term outcomes and complications after repeat MVD for HFS.
We performed repeat MVD on 78 consecutive patients who had undergone a prior MVD >1 year previously. Follow-up data were available for 58 patients, with a median follow-up period of 8.6 years (range, 6.9-10.2 years). The patients were assessed for intraoperative findings, relief results, and complications at discharge and at follow-up, as well as the associations between the preoperative characteristics and outcomes.
At discharge, of 78 patients with repeat MVD, 72 (92.3%) achieved complete spasm resolution and 1 (2.6%) had significantly improved spasm resolution. Of all patients, 9% (7 of 78) presented short-term complications, including partial hearing loss, hemifacial paresis, and cerebrospinal fluid leak. At follow-up, 45 of 58 (77.6%) patients had complete relief and 10 of 58 (17.2%) had improved relief. Permanent complications occurred in 14 patients (24.1%), with partial hearing loss and mild hemifacial paresis being the most common. Despite the complications, 51 of 58 patients (91.4%) reported an excellent life quality. No significant correlation was found between preoperative characteristics, such as age, interval to prior MVD, or interval to recurrence, and outcomes including short-term or long-term relief results and complications.
Repeat MVD provides lasting relief for most patients with persistent or recurrent HFS, albeit with a relatively high complication rate.
尽管对首次微血管减压术（MVD）失败的面肌痉挛（HFS）患者进行重复微血管减压术有潜在的治愈可能，但对于重复微血管减压术的长期效果知之甚少。我们旨在评估重复微血管减压术治疗面肌痉挛后的长期疗效和并发症。
我们对78例此前接受过MVD且时间超过1年的连续患者进行了重复微血管减压术。58例患者有随访数据，中位随访期为8.6年（范围6.9 - 10.2年）。评估患者的术中发现、缓解结果、出院时及随访时的并发症，以及术前特征与结果之间的关联。
出院时，78例接受重复微血管减压术的患者中，72例（92.3%）痉挛完全缓解，1例（2.6%）痉挛明显改善。所有患者中，9%（78例中的7例）出现短期并发症，包括部分听力丧失、面肌麻痹和脑脊液漏。随访时，58例患者中有45例（77.6%）完全缓解，10例（17.2%）缓解有所改善。14例患者（24.1%）出现永久性并发症，最常见的是部分听力丧失和轻度面肌麻痹。尽管有并发症，但58例患者中有51例（91.4%）报告生活质量良好。术前特征，如年龄、距首次MVD的间隔时间或复发间隔时间，与包括短期或长期缓解结果及并发症在内的结果之间未发现显著相关性。
重复微血管减压术可为大多数持续性或复发性面肌痉挛患者提供持久缓解，尽管并发症发生率相对较高。
