中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2015年
9期
878-881
,共4页
庞明志%鲁晓杰%李兵%王清
龐明誌%魯曉傑%李兵%王清
방명지%로효걸%리병%왕청
面肌痉挛%神经内镜%显微血管减压术
麵肌痙攣%神經內鏡%顯微血管減壓術
면기경련%신경내경%현미혈관감압술
Facial spasm%Neuroendoscope%Microvascular decompression
目的 针对原发性面肌痉挛术中难点,探讨神经内镜技术在局部解剖复杂的原发性面肌痉挛手术中的应用价值.方法 对南京医科大学附属无锡第二医院神经外科2008年1月至2012年1月收治的42例局部解剖复杂的面肌痉挛患者采用神经内镜辅助显微血管减压术,术中出现视野盲区时利用神经内镜对术区进行全方位的观察,探查面神经出脑干区及远端,并仔细辨别神经与血管的关系,确认责任血管,减压后用内镜再次检查有无责任血管遗漏、有无血管过度牵张、扭曲成角或形成新的压迫.术后对所有患者的临床资料、影像学资料进行回顾性分析并随访.结果 所有患者均随访18～ 30个月,平均25个月.41例术后完全缓解无复发(98％),3例出院时Shorr分级Ⅰ级的患者均恢复至0级,听力下降的1例患者在6个月内即完全恢复,1例Shorr分级Ⅱ级的患者至随访结束时没有明显加重.结论 神经内镜是显微血管减压术治疗面肌痉挛的有益补充,特别是在局部解剖复杂或异常的面肌痉挛患者,如后颅窝容积狭小、小脑绒球饱满、岩骨阻挡、局部蛛网膜粘连增厚及责任血管不易辨别的情况下结合内镜的优势能够提高手术效果.
目的 針對原髮性麵肌痙攣術中難點,探討神經內鏡技術在跼部解剖複雜的原髮性麵肌痙攣手術中的應用價值.方法 對南京醫科大學附屬無錫第二醫院神經外科2008年1月至2012年1月收治的42例跼部解剖複雜的麵肌痙攣患者採用神經內鏡輔助顯微血管減壓術,術中齣現視野盲區時利用神經內鏡對術區進行全方位的觀察,探查麵神經齣腦榦區及遠耑,併仔細辨彆神經與血管的關繫,確認責任血管,減壓後用內鏡再次檢查有無責任血管遺漏、有無血管過度牽張、扭麯成角或形成新的壓迫.術後對所有患者的臨床資料、影像學資料進行迴顧性分析併隨訪.結果 所有患者均隨訪18～ 30箇月,平均25箇月.41例術後完全緩解無複髮(98％),3例齣院時Shorr分級Ⅰ級的患者均恢複至0級,聽力下降的1例患者在6箇月內即完全恢複,1例Shorr分級Ⅱ級的患者至隨訪結束時沒有明顯加重.結論 神經內鏡是顯微血管減壓術治療麵肌痙攣的有益補充,特彆是在跼部解剖複雜或異常的麵肌痙攣患者,如後顱窩容積狹小、小腦絨毬飽滿、巖骨阻擋、跼部蛛網膜粘連增厚及責任血管不易辨彆的情況下結閤內鏡的優勢能夠提高手術效果.
목적 침대원발성면기경련술중난점,탐토신경내경기술재국부해부복잡적원발성면기경련수술중적응용개치.방법 대남경의과대학부속무석제이의원신경외과2008년1월지2012년1월수치적42례국부해부복잡적면기경련환자채용신경내경보조현미혈관감압술,술중출현시야맹구시이용신경내경대술구진행전방위적관찰,탐사면신경출뇌간구급원단,병자세변별신경여혈관적관계,학인책임혈관,감압후용내경재차검사유무책임혈관유루、유무혈관과도견장、뉴곡성각혹형성신적압박.술후대소유환자적림상자료、영상학자료진행회고성분석병수방.결과 소유환자균수방18～ 30개월,평균25개월.41례술후완전완해무복발(98％),3례출원시Shorr분급Ⅰ급적환자균회복지0급,은력하강적1례환자재6개월내즉완전회복,1례Shorr분급Ⅱ급적환자지수방결속시몰유명현가중.결론 신경내경시현미혈관감압술치료면기경련적유익보충,특별시재국부해부복잡혹이상적면기경련환자,여후로와용적협소、소뇌융구포만、암골조당、국부주망막점련증후급책임혈관불역변별적정황하결합내경적우세능구제고수술효과.
Objective To investigate the application value of neuroendoscope techniques in primary hemifacial spasm of the local complex anatomy aiming to the difficulties of primary hemifacial spasm surgery.Methods Forty-two patients with hemifacial spasm of the local complex anatomy were treated with neuroendoscope-assisted microvascular decompression at the Department of Neurosurgery,Wuxi No.2 Hospital Affiliated to Nanjing Medical University from January 2008 to January 2012.When the blind area appeared during the operation,a neuroendoscope was used to perform comprehensive observation of the surgical area,exploring the facial nerves from the brain stem area and distal end,and carefully distinguishing the relationship between the nerves and the blood vessels.The offending vessels were confirmed.After decompression,a neuroendoscope was use to reexamine whether there were omission of offending vessels and vascular excessive stretch,twisting in an angular shape,or formation of a new compression.The clinical and imaging data of all patients were analyzed retrospectively and were followed up after procedure.Results All patients were followed for 18-30 months (mean 25 months).Forty-one patients had complete remission after procedure without recurrence (98％),3 recovered from Shorr grade Ⅰ to grade 0 at discharge,1 with hearing loss was fully restored within 6 months,and 1 with Shorr grade Ⅱ did not obviously aggravate at the end of follow-up.Conclusions Neuroendoscopy is an useful complement to microvascular decompression for the treatment of hemifacial spasm,particularly in patients with local anatomical complex or unusual hemifacial spasm,such as combining the advantages of neuroendoscopy may improve the operation effect under the conditions of small posterior fossa volume,full cerebellum pompoms,rock bone block,local arachnoid adhesions and thickening,and identifying offending vessels with difficulty.
