CAJ | 학술논문

目的探讨神经内镜在显微血管减压术(MVD)治疗面肌痉挛(HFS)的应用价值.方法济宁市第一人民医院神经外二科自2006年12月至2009年12月应用神经内窥镜辅助下MVD治疗HFS患者118例,回顾性分析患者的临床资料和疗效.结果术中单纯经显微镜下发现责任血管的共106例(89.83%),其中有7例患者在神经内镜辅助下再次发现其它责任血管压迫;8例(6.78%)在显微镜下未见明显血管压迫,但经神经内镜发现有责任血管的存在.显微镜下减压完成后再用神经内镜观察,发现Teflon棉片未减压完全,需再次调整的17例(14.41%);术后102例(86.44%)痉挛立即消失,11例(9.32%)逐渐消失,3例(2.54%)部分缓解,2例(1.70%)无明显减轻,轻度复发.无脑脊液漏、偏瘫、死亡等严重并发症发生.结论神经内窥镜辅助下的MVD能清晰显示神经血管的解剖关系,减少对脑干、各颅神经的牵拉和重要血管的损伤,对提高手术疗效、减少复发率和术后并发症有重要价值.
목적 탐토신경내경재현미혈관감압술(MVD)치료면기경련(HFS)적응용개치.방법 제저시제일인민의원신경외이과자2006년12월지2009년12월응용신경내규경보조하MVD치료HFS환자118례,회고성분석환자적림상자료화료효.결과 술중단순경현미경하발현책임혈관적공106례(89.83%),기중유7례환자재신경내경보조하재차발현기타책임혈관압박;8례(6.78%)재현미경하미견명현혈관압박,단경신경내경발현유책임혈관적존재.현미경하감압완성후재용신경내경관찰,발현Teflon면편미감압완전,수재차조정적17례(14.41%);술후102례(86.44%)경련립즉소실,11례(9.32%)축점소실,3례(2.54%)부분완해,2례(1.70%)무명현감경,경도복발.무뇌척액루、편탄、사망등엄중병발증발생.결론 신경내규경보조하적MVD능청석현시신경혈관적해부관계,감소대뇌간、각로신경적견랍화중요혈관적손상,대제고수술료효、감소복발솔화술후병발증유중요개치.
Objective To explore the value ofneuroendoscope in microvascular decompression for treatment of primary hemifacial spasm. Methods One hundred and eighteen patients with hemifacial spasm, admitted to our hospital from December 2006 to December 2009, underwent endoscope-assisted microvascular decompression via suboccipital retrosigmoid approach; their clinical data and treatment efficacy were retrospectively analyzed. Results The offending vessels were found in 106 patients (89.83%) under microscope, of which 7 (5.93%) were again found other offending vessels under neuroendoscope. Eight patients (6.78%) were noted as no significant vascular compression under microscope, but the offending vessels of these patients existed under endoscope. Seventeen patients performed decompression with Teflon cotton under microscope needed modification when they were checked under endoscope. The symptoms of 102 patients (86.44%) disappeared immediately after the operation; 11 (9.32%) disappeared gradually; 3 (2.54%) had partial remission and 2 (1.70%) had no significantly remission. No serious complications, including cerebrospinal leakage, paralysis and death, were noted. Conclusion Endoscope-assisted microvascular decompression, by improving the observation of the anatomic neurovascular relation, decreasing the damage to the brain stem, nerves and important vessels, can improve the surgical treatment, and reduce the recurrence rate and postoperative complications.