CAJ | 학술논문

目的探讨面神经远端血管压迫对面肌痉挛显微血管减压术疗效的影响.方法采用监测面神经侧方扩散反应(LSR)的方法,对120例面肌痉挛患者进行术中监测,通过对39例单纯面神经根出脑干区减压后LSR未消失的病例探查而神经蛛网膜下腔段全长(面神经远端),发现19例面神经远端存在血管压迫,进行充分减压,记录监测结果并观察手术疗效.结果手术结束时15例LSR消失,4例LSR未消失.术后面肌痉挛症状完全消失13例,减轻但未完全消失6例.随访8-14个月,平均12.7个月,所有患者面肌痉挛症状均完全消失,无复发病例.术后并发症包括:中度面瘫2例,均于随访期间恢复正常;听力丧失1例,未恢复;听力下降3例,随访期间1例恢复正常,2例较前好转;颅内感染1例,住院期间完全控制.结论面神经远端血管压迫对面肌痉挛手术的疗效有明确影响,根据监测结果对其进行减压能够降低术后延迟治愈的发生率并减少盲目处理面听神经相关血管导致并发症的发生.
목적 탐토면신경원단혈관압박대면기경련현미혈관감압술료효적영향.방법 채용감측면신경측방확산반응(LSR)적방법,대120례면기경련환자진행술중감측,통과대39례단순면신경근출뇌간구감압후LSR미소실적병례탐사이신경주망막하강단전장(면신경원단),발현19례면신경원단존재혈관압박,진행충분감압,기록감측결과병관찰수술료효.결과 수술결속시15례LSR소실,4례LSR미소실.술후면기경련증상완전소실13례,감경단미완전소실6례.수방8-14개월,평균12.7개월,소유환자면기경련증상균완전소실,무복발병례.술후병발증포괄:중도면탄2례,균우수방기간회복정상;은력상실1례,미회복;은력하강3례,수방기간1례회복정상,2례교전호전;로내감염1례,주원기간완전공제.결론 면신경원단혈관압박대면기경련수술적료효유명학영향,근거감측결과대기진행감압능구강저술후연지치유적발생솔병감소맹목처리면은신경상관혈관도치병발증적발생.
Objectiye To study the influence of distal portion compression of the facial nerve in hemifacial spasm surgery.Method 120 hemifacial spasm patients were undergone lateral spread response monitoring during microvascular decompression surgery.39 patients' LSR remained after decompression of the root exit zone of the facial nerve.After exploring the full length of distal portion of the facial nerve in the subarachnoid space, 19 patients were found distal portion vascular compression and were fully decompressed.The monitoring records as long as the surgical results were analyzed post - operatively.Results At the end of operations, 15 patients' LSR disappeared and 4 remained.The HFS disappeared immediately in 13patients.The post - operative spasm was weaker in 6 patients.After follow - up period of 8 - 14 months ( mean duration 12.7 months), all patients were spasm free and no reoccurrence case.Post - operative complications included:2 cases of transient moderate facial paralysis, 1 case of hearing loss, 3 cases of transient hearing impairment and 1 case of intracranial infection.Conclusions Distal portion compression of the facial nerve has influence on the result of microvascular decompression surgery.Distal decompression which identified by intraoperative monitoring can decrease the occurrence of delayed resolution and minimize the complications related with decompression of the vascular attached to the Ⅶ and Ⅷ nerve.