CAJ | 학술논문

目的：评价内镜辅助下经小脑脑桥裂入路微血管减压术（microvascular decompression ，MVD）治疗面肌痉挛（hemifacial spasm ，HFS）的临床疗效。方法回顾性分析临床确诊为 HFS ，内镜辅助下经小脑脑桥裂上、下支入路行个体化M VD治疗的349例患者，对术后患者行1 a以上的随访观察及统计。结果349例患者术中均发现有责任血管压迫。随访分析统计，349例患者治愈311例，好转18例，无效20例，总有效率94.3％。术后复发者8例，复发率2.3％。术后无死亡病例，出现面神经麻痹31例（8.9％），听力下降15例（4.3％），吞咽困难7例（2.0％），术后脑脊液漏致颅内严重感染1例（0.3％），经治疗后治愈或者好转。结论内镜辅助下小脑脑桥裂上、下支入路面神经M VD ，有利于探查责任血管的位置，减轻面神经及听神经的牵拉，从而有助于提高总有效率，减少并发症的发生率及降低复发率。
목적：평개내경보조하경소뇌뇌교렬입로미혈관감압술（microvascular decompression ，MVD）치료면기경련（hemifacial spasm ，HFS）적림상료효。방법회고성분석림상학진위 HFS ，내경보조하경소뇌뇌교렬상、하지입로행개체화M VD치료적349례환자，대술후환자행1 a이상적수방관찰급통계。결과349례환자술중균발현유책임혈관압박。수방분석통계，349례환자치유311례，호전18례，무효20례，총유효솔94.3％。술후복발자8례，복발솔2.3％。술후무사망병례，출현면신경마비31례（8.9％），은력하강15례（4.3％），탄인곤난7례（2.0％），술후뇌척액루치로내엄중감염1례（0.3％），경치료후치유혹자호전。결론내경보조하소뇌뇌교렬상、하지입로면신경M VD ，유리우탐사책임혈관적위치，감경면신경급은신경적견랍，종이유조우제고총유효솔，감소병발증적발생솔급강저복발솔。
Objective To study the clinical effect of microvascular decompression (MVD) by endoscope‐assisted trans‐cer‐ebellopontine fissure approach for hemifacial spasm (HFS).Methods 349 cases with HFS who received individualized MVD therapy by trans‐cerebellopontine fissure approach were analyzed retrospectively. All cases were observed during more than one year follow‐up.Results The compressions of offending vessels were found in 349 cases. Follow‐up analysis of the statistics showed cure in 311 cases ,improvement in18 cases and non‐effect in 20 cases ,with total efficiency rate of 94.3%. 8 cases were relapsed after operation with recurrent rate of 2.3%. No patient died after follow‐up and facial spasm presented in 31 patients (8.9% ) ,hearing disturbance occurred in 15 (4.3% ) ,swallowing difficulties happened in 7patients (2% ) ,and 1 patient (0.29% )suffered from severe intracranial infection resulting from cerebrospinal fluid leakage which cured or tuned to better af‐ter treatment.Conclusion Microvascular decompression (MVD) by endoscope‐assisted trans‐cerebellopontine fissure approach for hemifacial spasm (HFS) is useful to find positions of offending vessels ,to reduce tension of facial‐acoustic nerve ,which can improve the total effective rate and decrease the incidence of complications and recurrent rate.