CAJ | 학술논문

目的探讨青年面肌痉挛(HFS)患者的临床特征、发病原因及显微血管减压术的治疗效果.方法 2010年1月至2013年12月南京大学医学院附属鼓楼医院神经外科采用显微血管减压术治疗HFS患者982例,回顾性分析其中17例(1.7％)发病年龄≤22岁患者的临床特征及治疗效果.结果 17例患者均为单侧HFS;其中男4例,女13例;发病年龄14 ～ 22岁,平均为(19.4±2.3)岁;病程l～11年,平均为(5.5±3.0)年.术前MRI显示,17例责任血管平均外径为(1.66 ±0.81)mm,后颅窝平均夹角为(29.92±4.78)..术中均可见责任动脉压迫面神经根出脑干区,14例可见不同程度的局部解剖变异、责任动脉异常.16例获得临床治愈,其中14例术后即刻治愈,延迟治愈2例(术后1、3个月),随访至今(1 ～3年)未复发;术后10 d复发1例;迟发性面瘫(术后第14天)及声音嘶哑各1例,治疗后均好转.结论在HFS患者中,青年患者所占的比率较低.局部解剖变异,责任动脉异常导致动脉压迫面神经根部是其主要的发病原因.显微血管减压术对其有较好的疗效.
목적 탐토청년면기경련(HFS)환자적림상특정、발병원인급현미혈관감압술적치료효과.방법 2010년1월지2013년12월남경대학의학원부속고루의원신경외과채용현미혈관감압술치료HFS환자982례,회고성분석기중17례(1.7％)발병년령≤22세환자적림상특정급치료효과.결과 17례환자균위단측HFS;기중남4례,녀13례;발병년령14 ～ 22세,평균위(19.4±2.3)세;병정l～11년,평균위(5.5±3.0)년.술전MRI현시,17례책임혈관평균외경위(1.66 ±0.81)mm,후로와평균협각위(29.92±4.78)..술중균가견책임동맥압박면신경근출뇌간구,14례가견불동정도적국부해부변이、책임동맥이상.16례획득림상치유,기중14례술후즉각치유,연지치유2례(술후1、3개월),수방지금(1 ～3년)미복발;술후10 d복발1례;지발성면탄(술후제14천)급성음시아각1례,치료후균호전.결론 재HFS환자중,청년환자소점적비솔교저.국부해부변이,책임동맥이상도치동맥압박면신경근부시기주요적발병원인.현미혈관감압술대기유교호적료효.
Objective To investigate the clinical characteristics,causes and surgical treatment of young onset hemifacial spasm patients.Methods A total of 982 patients underwent microvascular decompression (MVD) for hemifacial spasm (HFS) in Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School from January,2010 to December,2013.17 patients with the onset age ≤22 years old were analyzed retrospectively.Results Among the 17 unilateral HFS patients,4 were males and 13 were females.The mean age of onset was [19.4 ±2.3(14-22)] years.The mean duration before operation was [5.5 ± 3.0 (1-11)] years.The preoperative MRI showed that the average outside diameter of the offending vessels was (1.66 ± 0.81) mm,the average angle of the posterior fossa was (29.92 ± 4.78) °.The offending arteries were observed in all patients.The local anatomic variations and exceptional arteries were found in 14 patients.16 patients got a clinical resolution,of which 14 cases were cured immediately,delayed resolution (1,3 months after surgery) was found in two cases,without recurrence during the follow-up period(1-3 years).One patient relapsed 10 d after the surgery.One case of delayed facial paralysis (14 days after surgery) and one hoarseness were observed.Conclusions Young onset HFS patients were rare.Exceptional arteries and anatomic structural variation might be the main causes of this disease.MVD had good effect.