Abstract

Purpose

Microvascular decompression (MVD) surgery has been accepted as a potentially curative method for hemifacial spasm (HFS). The primary cause of failure of MVD is incomplete decompression of the offending vessel due to inadequate visualization. This study is aimed at evaluating the benefit of endoscopic visualization and the value of fully endoscopic MVD.

Methods

From March 2016 to March 2018, 45 HFS patients underwent fully endoscopic MVD in our department. From opening the dura to preparing to close, the assistant held the endoscope and the surgeon operated. Abnormal muscle response (AMR) and brainstem auditory evoked potentials (BAEP) were monitored. For every patient, the offending vessel was transposed or interposed and achieved complete decompression. AMR was used to evaluate the adequacy of decompression at the end of the surgery. The intra-operative findings and postoperative outcomes and complications were analyzed.

Results

Immediately after surgeries, 39 patients (86.7%) achieved excellent result; 2 cases (4.4%) had good result. So the postoperative effective rate was 91.1% (41/45). During 12–36 month follow-up, the outcomes were excellent in 42 cases (93.3%) and good in 2 cases (4.4%), and the effective rate reached to 97.8% (44/45). No recurrence was noted. The postoperative complications were found in 2 patients (4.4%). One patient (2.2%) showed delayed facial palsy on the tenth day but was fully recovered 1 month later. Intracranial infection was noticed in 1 patient (2.2%) and was cured by using intravenous antibiotics for 2 weeks. There was no hearing impairment, hoarseness, or other complications.

Conclusions

Fully endoscopic MVD is both safe and effective in the treatment of HFS. Electrophysiological monitoring is helpful to gain a good result and reduce hearing impairment.

中文翻译：

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内镜对面肌痉挛的完全减压：我们的经验。

摘要

目的

微血管减压（MVD）手术已被认为是治疗面肌痉挛（HFS）的潜在方法。MVD失败的主要原因是由于可视化不充分导致病变血管的减压不完全。这项研究旨在评估内窥镜可视化的好处和完全内窥镜MVD的价值。

方法

从2016年3月至2018年3月，我科共对45例HFS患者进行了全内镜下MVD检查。从打开硬脑膜到准备关闭硬脑膜，助手都拿着内窥镜，外科医生开始手术。监测异常的肌肉反应（AMR）和脑干听觉诱发电位（BAEP）。对于每位患者，将病变血管置入或置入并完全减压。在手术结束时使用AMR评估减压的适当性。分析了术中发现，术后结果和并发症。

结果

手术后即刻，有39例患者（86.7％）取得了优异的效果。2例（4.4％），效果良好。因此，术后有效率为91.1％（41/45）。在12-36个月的随访中，结果42例（93.3％）良好，2例（4.4％）良好，有效率为97.8％（44/45）。没有发现复发。2例（4.4％）发现术后并发症。一名患者（2.2％）在第十天出现面神经麻痹，但在1个月后完全康复。1名患者（2.2％）发现颅内感染，并通过静脉使用抗生素治疗了2周。没有听力障碍，声音嘶哑或其他并发症。

结论

完全内窥镜MVD在治疗HFS中既安全又有效。电生理监测有助于获得良好的结果并减少听力障碍。