Barker F G, Jannetta P J, Bissonette D J, Shields P T, Larkins M V, Jho H D
Department of Neurological Surgery, Presbyterian-University Hospital, University of Pittsburgh School of Medicine, Pennsylvania.
J Neurosurg. 1995 Feb;82(2):201-10. doi: 10.3171/jns.1995.82.2.0201.
The authors report the results of 782 microvascular decompression procedures for hemifacial spasm in 703 patients (705 sides), with follow-up study from 1 to 20 years (mean 8 years). Of 648 patients who had not undergone prior intracranial procedures for hemifacial spasm, 65% were women; their mean age was 52 years, and the mean preoperative duration of symptoms was 7 years. The onset of symptoms was typical in 92% and atypical in 8%. An additional 57 patients who had undergone prior microvascular decompression elsewhere were analyzed as a separate group. Patients were followed prospectively with annual questionnaires. Kaplan-Meier methods showed that among patients without prior microvascular decompression elsewhere, 84% had excellent results and 7% had partial success 10 years postoperatively. Subgroup analyses (Cox proportional hazards model) showed that men had better results than women, and patients with typical onset of symptoms had better results than those with atypical onset. Nearly all failures occurred within 24 months of operation; 9% of patients underwent reoperation for recurrent symptoms. Second microvascular decompression procedures were less successful, whether the first procedure was performed at Presbyterian-University Hospital or elsewhere, unless the procedure was performed within 30 days after the first microvascular decompression. Patient age, side and preoperative duration of symptoms, history of Bell's palsy, preoperative presence of facial weakness or synkinesis, and implant material used had no influence on postoperative results. Complications after the first microvascular decompression for hemifacial spasm included ipsilateral deaf ear in 2.6% and ipsilateral permanent, severe facial weakness in 0.9% of patients. Complications were more frequent in reoperated patients. In all, one operative death (0.1%) and two brainstem infarctions (0.3%) occurred. Microvascular decompression is a safe and definitive treatment for hemifacial spasm with proven long-term efficacy.
作者报告了对703例患者（705侧）进行的782例微血管减压术治疗面肌痉挛的结果，随访时间为1至20年（平均8年）。在648例此前未接受过颅内面肌痉挛手术的患者中，65%为女性；她们的平均年龄为52岁，术前症状平均持续时间为7年。92%的患者症状发作典型，8%不典型。另外57例此前在其他地方接受过微血管减压术的患者作为单独一组进行分析。通过年度问卷对患者进行前瞻性随访。Kaplan-Meier方法显示，在其他地方未接受过微血管减压术的患者中，术后10年84%效果极佳，7%部分成功。亚组分析（Cox比例风险模型）显示，男性效果优于女性，症状发作典型的患者效果优于不典型患者。几乎所有失败都发生在术后24个月内；9%的患者因症状复发接受了再次手术。第二次微血管减压术成功率较低，无论首次手术是在长老会大学医院还是其他地方进行，除非首次微血管减压术后30天内进行该手术。患者年龄、患侧、术前症状持续时间、贝尔面瘫病史、术前是否存在面部无力或联带运动以及所用植入材料对术后结果均无影响。首次微血管减压术治疗面肌痉挛后的并发症包括2.6%的患者出现同侧耳聋，0.9%的患者出现同侧永久性严重面部无力。再次手术患者并发症更常见。总共发生1例手术死亡（0.1%）和2例脑干梗死（0.3%）。微血管减压术是治疗面肌痉挛的一种安全且有效的确定性治疗方法，长期疗效已得到证实。
