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目的 探讨显微血管减压术(MVD)治疗责任血管包括椎动脉(VA)的面肌痉挛(HFS)的手术技巧、疗效以及并发症.方法 回顾性纳入2010年1月至2012年2月卫生计生委中日友好医院神经外科采用MVD治疗的783例HFS患者,其中125例(16.0％)责任血管中包括VA(VA组),658例(84.0％)责任血管中不包括VA(非VA组).分析两组的临床特点、手术技巧、疗效以及并发症情况.结果 VA组中,责任血管为VA合并其他动脉者120例(96.0％),其中VA单独或共同作为主要责任血管者11例,VA为次要责任血管者109例;VA为惟一责任血管者5例(4.0％).与非VA组相比,VA组多发于男性,HFS多位于左侧(均P＜0.05).术后平均随访51个月(46 ～ 60个月).VA组的手术复发率,延迟治愈率,中位延迟治愈时间,以及患侧听力严重受损、患侧即刻面瘫、患侧迟发性面瘫、后组脑神经损伤、颅内出血的发生率均高于非VA组(均P＜0.05),VA组与非VA组在年龄、HFS病程、手术总有效率以及无效率方面的差异均无统计学意义(均P＞0.05).结论 在HFS MVD术中发现,VA作为惟一责任血管者少见;VA与其他动脉共同压迫时多为次要责任血管.MVD治疗责任血管包括VA的HFS疗效确切,但与责任血管不包括VA者相比,前者更易出现延迟治愈,且延迟治愈时间较长,也更易于复发;术后并发症的发生率高于责任血管不包括VA者.

Objective To discuss the surgical techniques,outcomes and complications of microvascular decompression (MVD) for treatment of hemifacial spasm (HFS) with offending vessels including the vertebral artery (VA).Methods A total of 783 patients with HFS undergoing MVD at Department of Neurosurgery,China-Japan Friendship Hospital from January 2010 and February 2012 were retrospectively enrolled into this study.Among them,125 cases (16.0％) were found to have offending vessels including VA and were classified into VA group.The other 685 cases (84.0％) did not have VA as the offending vessel and belonged to non-VA (NVA) group.The clinical characteristics,surgical techniques,efficacies and complications were analyzed for the two groups.Results In the VA group,120 cases (96.0％) had offending vessels including VA and other arteries.Out of the 120 cases,VA acted as the only main offending vessel or one of the main offending vessels in 11 cases,and as the secondary offending vessel in 109 cases.VA was identified as the only offending vessel in 5 cases (4.0％).Compared with the NVA group,the symptoms in VA group seemed to affect more commonly the left side and male patients (all P ＜0.05).The mean follow-up time is 51 months (range from 46 to 60 months).In the VA group,the postoperative recurrence rate,delayed curing rate,median delayed curing time and rates of significant ipsilateral hearing loss,immediate postoperative facial paralysis,delayed facial paralysis,injury of posterior group of cranial nerves as well as intracranial bleeding were all higher than those in NVA group,and the differences were statistically significant (all P ＜ 0.05).Between the two groups,no difference was identified in the patient's age,duration of illness,effective or non-effective rate of operation (all P ＞ 0.05).Conclusions It seems uncommon that VA acts as the only major offending vessel,which tends to be the secondary offending vessel and results in compression together with other arteries.The efficacy of MVD in HFS involving offending vessels including VA is suggested to be certain.Compared with the NVA patients,delayed curing is more likely to occur with later remission and higher rate of recurrence in VA patients.Postoperative complications post MVD are more commonly observed in VA patients than in NVA patients.