Re-operation for persistent hemifacial spasm after microvascular decompression with the aid of intraoperative monitoring of abnormal muscle response
Re-operation for persistent hemifacial spasm after microvascular decompression with the aid of intraoperative monitoring of abnormal muscle response
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DOI：
10.1007/s00701-010-0837-9
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发表时间：
2010-12-01
影响因子：
2.4
通讯作者：
Zheng, Xuesheng
中科院分区：
文献类型：
--
作者：
Li, Shiting;Hong, Wenyao;Zheng, Xuesheng
微血管减压（MVD）是唯一可以有效控制面肌痉挛（HFS）的解决方案。对于第一次手术失败的患者的治疗，目前仍存在争议。我们试图评估此类患者早期再探查的安全性和效率。13名患者第一次MVD失败，接受了第二次MVD手术。第一次 MVD 后，痉挛根本没有缓解，或者变得更加严重。异常肌肉反应（AMR）在第一次 MVD 手术期间持续存在或消失一次但又出现。患者再次手术意愿强烈，并意识到手术并发症的高风险。13例患者再次手术后均获得良好或优异的痉挛缓解，包括全程探查和术中AMR监测；但有2例（15.4%）出现永久性面部无力，3例（23.0%）出现短暂性面部无力。我们早期重复MVD的经验是全范围探查和术中AMR监测；也就是说，再手术不能太依赖经验。
Microvascular decompression (MVD) is the only solution that can effectively control hemifacial spasm (HFS). Regarding treatment of the patients who failed the first operation, it is still controversial. We tried to evaluate the safety and efficiency of the early re-exploration for such kinds of patients.Thirteen patients failed the first MVD and received a second MVD procedure. The spasm was not resolved at all or became even more severe after the first MVD. Abnormal muscle response (AMR) persisted during the first MVD operation or disappeared once but emerged again. The patient had a strong will to do the re-operation and was aware of the high risks of operative complications.All the 13 patients got good or excellent spasm resolution immediately after the re-operation, which involved whole-range exploration and intraoperative AMR monitoring; however, there were two cases (15.4%) of permanent facial weakness and three cases (23.0%) of transient facial weakness.Our experience on early repeat MVD is whole-range exploration and intraoperative AMR monitoring; in other words, re-operation cannot rely too much on experience.