摘要：

目的 探讨微血管减压术治疗面肌痉挛的手术要点及有效性和安全性。方法 共 54 例面肌痉挛患者，责任血管分别为小脑前下动脉 32 例（59.26%）、小脑后下动脉 11 例（20.37%）、椎动脉 5 例（9.26%），其中 6 例（11.11%）为多责任血管，均行微血管减压术。结果 54 例患者平均随访 2 年，面肌痉挛治愈 46 例（85.19%）、明显缓解 5 例（9.26%）、部分缓解 2 例（3.70%）、无效 1 例（1.85%），总有效率为94.44%（51/54）。术后出现轻度面瘫 4 例（7.41%）、听力下降 2 例（3.70%）、延迟治愈 4 例（7.41%），无一例发生颅内血肿、颅内感染和脑脊液漏，无死亡病例。结论 微血管减压术治疗面肌痉挛安全、有效。熟练的手术技巧、准确的责任血管判定、面神经有效减压是手术成功的关键，术中神经电生理学监测可以实时判断手术疗效、减少术后并发症。

关键词: 面部单侧痉挛, 显微外科手术

Abstract:

Objective To analyze the operating points and evaluate the therapeutic efficacy and safety of microvascular decompression (MVD) for hemifacial spasm (HFS). Methods The clinical data of 54 patients with HFS underwent MVD were analyzed retrospectively. The offending vessels included anterior inferior cerebellar artery (AICA) in 32 cases (59.26%), posterior inferior cerebellar artery (PICA) in 11 cases (20.37%), vertebral artery (VA) in 5 cases (9.26%), both AICA and PICA in 6 cases (11.11%). Results  After an average of 2 years of follow-up, 46 cases (85.19%) were completely relieved, 5 cases (9.26% ) were markedly relieved, 2 cases (3.70% ) were partially relieved, and one case (1.85% ) had no significant change. The total effective rate was 94.44% (51/54). There were 4 cases (7.41% ) with mild facial paralysis, 2 cases (3.70% ) with hearing loss, and 4 cases (7.41% ) with delayed resolution after operation, and no intracranial hematoma, intracranial infection, cerebrospinal fluid (CSF) leakage or death occurred during the perioperative period. Conclusions  MVD is effective and safe in the treatment of HFS. Adept operation skills, correct identification of offending vessels, and effective decompression are the key to successful operation. Intraoperative electrophysiological monitoring can be used to identify the effect of operation and reduce postoperative complications.

Key words: Hemifacial spasm, Microsurgery