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目的探讨面肌痉挛微血管减压治疗的术前评估和手术技巧。方法 23例共21例经MRTA检查确认面神经REZ存在责任血管的面肌痉挛患者,采用乙状窦后入路微血管减压治疗,对比观察术中发现责任血管情况,并随访分析手术疗效。结果 21例经MRTA检查术中20例在面神经REZ发现了责任血管并进行了充分减压,术后21例病人抽搐症状完全消失,2例术后症状减轻,1月后症状消失;术后出现1例患者在术后5d出现迟发性面瘫,经针灸、理疗、药物治疗等处理,1月后治愈;无死亡病例;无脑脊液漏、颅内感染及颅内血肿等严重并发症。结论微血管减压术是血管源性面肌痉挛有效的治疗方法,术前MRTA评估、术中准确判定责任血管并充分减压有助于提高手术疗效。
Objective To investigate the preoperative evaluation and surgical technique of hemifacial spasm microvascular decompression. Methods A total of 21 patients with facial nerve spasm of REZ who had facial nerve REZ confirmed by MRTA were treated with microvascular decompression of sigmoid sinus in 23 patients. Twenty-one patients were followed up to analyze the operative effect. Results Twenty patients undergoing MRTA in operation were found to have a responsible vessel in REZ of the facial nerve and decompression was performed. The symptoms of twitch in 21 patients disappeared completely after operation. Symptoms were relieved in 2 patients and disappeared after 1 month. One patient had delayed facial paralysis 5d after operation. After 1 month, he was treated with acupuncture, physiotherapy and medical treatment. No deaths were found. No serious complications such as cerebrospinal fluid leakage, intracranial infection and intracranial hematoma occurred. Conclusion Microvascular decompression is an effective treatment for vasogenic hemifacial spasm. The preoperative MRTA assessment, accurate assessment of responsible blood vessels during surgery and adequate decompression help to improve the curative effect.