【摘要】 目的　探讨影响显微血管减压术治疗面肌痉挛手术效果及并发症发生的因素。方法　回顾性分析12 0 0例经显微血管减压术治疗的面肌痉挛临床资料。手术采用经绒球小结叶入路显露面神经脑干段 ,明确责任血管后将其推移 ,在血管与脑干之间放置Teflon棉固定。术中采用实时脑干听觉诱发电位监测。结果　全部病例术中均发现有明确的压迫血管 ,责任血管中小脑前下动脉占 4 2 .6 % ,椎动脉为主要责任血管时均伴有多个血管共同压迫面神经根部。全部病例经 2～ 10年随访 ,平均 4 .2年 ,抽搐完全消失 88.7% ,减轻 5 .6 % ,总有效率为 94 .3% ;手术无效 2 .6 % ,复发 3.2 %。听力障碍 2 .8%。结论　显微血管减压术是面肌痉挛最有效的治疗方法 ,术中面神经根部的显露、责任血管的识别、减压棉片的放置等是影响手术效果的关键 ;术中实时脑干听觉诱发电位监测、避免颅神经和细小穿支血管损伤 ,能有效防止听力障碍等并发症发生。更多还原

【Abstract】 Objective This study investigates the factors that related to the impacts and postoperative complications of microvascular decompression (MVD) on hemifacial spasm (HFS).Methods 1200 cases of HFS patients treated with MVD operation were studied retrospectively.During operation the root exit zone (REZ) of facial nerve was exposed through the intraflocculus approach,the offending vessels (OV) were identified and seperated away from REZ,A Teflon graft was interpositioned between OV and brainstem.Intra～operative monitoring of brain stem auditory evoked potential(BAEP) was performed in all cases.Results In all cases OV(s) can be identified.Anterior-inferior cerebellar artery was offending vessel in 42.6% of cases.Multiple vascular compressions were observed in all cases of vertebral artery compression.The Follow-up was 2～10 years (mean 4.2 years).88.7% cases were cured,5.6% relieved,the total effective rate was 94.3%.Recurrence rate was 3.2%,and the inefficacy rate was 2.6%.The most frequent complication was hearing dysfunction (2.8%).Conclusion MVD operation is the most available treatment to HFS.The key points of the MVD operation include good exposure of REZ,correct identifying of the OV,and proper positioning of Teflon grafts.The rate of complications can be reduced significantly by fewer disturbance to cranial nerves,avoiding the injury to the penetrating vessels in REZ,and utilizing real-time BAEP monitoring during operation.更多还原