[Microsurgical vascular decompression for hemifacial spasm. Follow-up over one year, clinical results and prognostic factors. Study of a series of 100 cases].
[Microsurgical vascular decompression for hemifacial spasm. Follow-up over one year, clinical results and prognostic factors. Study of a series of 100 cases].
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发表时间：
2003-11
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通讯作者：
V. Marneffe;G. Polo;C. Fischer;M. Sindou
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作者：
V. Marneffe;G. Polo;C. Fischer;M. Sindou
背景和目的报道了100例采用显微血管减压术（MVD）治疗面肌痉挛（HFS）的患者的结果。方法采用乳突后锁孔入路，在脑干听觉诱发电位（BAEP）和面神经肌电图（EMG）的监测下，将VII神经从冲突血管中分离出来，并插入Teflon纤维和/或滤网。结果小脑前下动脉57例，小脑后下动脉56例，椎基底动脉22例。32例（32%）存在多重冲突。如果没有残余痉挛，则结果被认为是极好的，如果仅“最小抽搐”保持且缓解> 80%，则结果被认为是良好的，如果痉挛缓解20 - 80%，则结果被认为是差的，如果缓解<20%，则结果被认为是失败的。术后随访1 ~ 18年（平均5年），75例（75%）患者出院时MVD疗效满意（优或良），85例（85%）患者术后MVD疗效满意（优或良）。在后者患者中，29例（34%）出现延迟（1例长达3（1/2）年）治愈。9例出院后痉挛复发。我们遇到了以下永久性神经系统并发症：1例面瘫，7例听力障碍（其中5例完全），1例IX-X缺陷。无脑干或小脑死亡或缺血并发症。我们的大多数听力并发症发生在使用术中BAEP监测之前（我们的前7名患者中有3例共音，而我们的后93名患者中有2例）。局部并发症包括：1例脑膜炎，8例脑脊液漏，需要进行一系列腰椎穿刺或腰椎外引流，3例伤口感染和/或伤口愈合延迟，需要手术治疗。结论：我们的数据与文献中的数据一致，特别是关于高的长期成功率和低并发症率的MVD治疗HFS。我们不建议在初始结果不佳的情况下早期再次手术。再次强调术中BAEP监测预防听力损伤的必要性。
BACKGROUND AND PURPOSE The results of a series of 100 patients operated on for hemifacial spasm (HFS), using microsurgical vascular decompression (MVD), are reported. METHOD MVD was performed through a retromastoid keyhole approach, under monitoring of brainstem auditory evoked potentials (BAEP) and facial EMG, and consisted in dissection of VII nerve from conflicting vessel(s), and interposition of Teflon fibers and/or screen(s). RESULTS The offending vessels found were: the antero-inferior cerebellar artery in 57 cases, the postero-inferior cerebellar artery in 56 cases, the vertebrobasilar artery in 22 cases. A multiple conflict was found in 32 cases (32%). The result was considered excellent if there was no residual spasm, good if only "minimal twitching" remained with relief>80%, poor for spasm relief 20 to 80%, and as a failure if relief<20%. The effect of MVD was satisfying (excellent or good) in 75 patients (75%) at discharge (10th day) and in 85 (85%) after 1 to 18 years follow-up (mean: 5 years). Amongst the latter patients, 29 (34%) experienced a delayed (up to 3(1/2) years in one) cure. Spasm recurrence was noted in 9 cases after satisfying effect on discharge. We encountered following permanent neurological complications: 1 facial palsy, 7 cases of hearing deficit (5 of them complete), and 1 case of IX-X deficit. Neither death nor ischaemic complication at brainstem or cerebellum. Most of our hearing complications occurred before using intraoperative BAEP monitoring (3 cases of cophosis among our first 7 patients vs 2 out of our last 93). Local complications were: 1 meningitis, 8 cases of CSF leakage requiring either a series of lumbar punctures or a lumbar external drain, and 3 cases of wound infection and/or delayed woundhealing requiring surgical treatment. CONCLUSIONS Our data are consistent with those of the literature, especially concerning high rate of long-term success and low complication rate of MVD for HFS. We do not recommend early re-operation in case of initial poor result. Again, the necessity of intraoperative BAEP monitoring to prevent hearing morbidity is highlighted.