Facial twitch microvascular decompression

Facial muscle twitching is a lateral dysfunctional dysfunction syndrome, and a small number of patients may have trigeminal neuralgia or glossopharyngeal neuralgia. The traditional treatment method is to cause damage to the facial nerve trunk or its surrounding branches, to achieve the purpose of reducing or stopping the facial muscle twitching, but the dominant facial muscles also have paralysis. Such methods include ethanol injection around the facial nerve and selective severance of the peripheral nerve. In recent years, the ethanol injection and temperature-controlled radiofrequency treatment of the facial nerve in the stem of the stem have been carried out. At present, most of the pathogenesis of this disease is caused by the compression of the facial nerve by the ectopic blood vessels in the nerve root adjacent to the brain stem. Campbell and Keedy found ectopic vascular compression facial nerves in 2 patients with facial muscle twitching in 1947. Gardner used neurovascular decompression in 1959 to treat facial muscle twitching. Jannetta et al. used neurosurgical decompression in 1966. The cure rate was 85.1% in 47 cases, indicating that the effective decompression zone is adjacent to the brain stem. The root of the facial nerve. Matsushima passed the autopsy data in 1990 to further support Jannetta's argument. Domestic Zuo Huanzong reported this operation in 1981. Duan Yunping reported 233 cases of cerebellar pons angina neurovascular decompression in 1988, including 50 cases of facial muscle twitching. During the operation, many patients were found to be aware of local anesthesia. Next, when the arachnoid thickened on the surface of the facial nerve is cut, the facial muscle twitch of the patient disappears immediately (the facial pain of the patient with trigeminal neuralgia suddenly disappears). Therefore, in addition to the pressure of the ectopic blood vessels on the nerves, the local arachnoid thickening and adhesion is another important factor contributing to the compression of the nerve roots. Kobata et al (1995) believe that middle-aged and elderly patients are mostly caused by arteriosclerosis; young patients <30 years old are mostly caused by arachnoid thickening and compression of the facial nerve. This decompression can both eliminate the cause of the disease and retain the original nerve function. Therefore, the application is quite extensive. In the reports of domestic and foreign literatures, the effective rate of this method is 87.5% to 94.1%, and the recurrence rate is 5.9% to 12.5%. Treatment of diseases: facial muscle twitching Indication 1. The facial muscle twitch attacks are frequent and serious, affecting people who work and live daily. 2. The disease is not ideal after other treatments, or relapse after decompression. Contraindications 1. The symptoms are mild and the episodes are infrequent. 2. Intentional facial muscle twitching, mostly bilateral. 3. Patients with severe hypertension and heart and kidney disease, as well as severe epilepsy. Preoperative preparation 1. Female patients can be limited to the side pillow and the lower part of the pillow. 2. Preoperative treatment to the patient, the operation should be well coordinated, repeated stimulation of the face, to observe the facial muscle twitch disappeared. Surgical procedure Scalp incision A 1.5cm incision is made inward of the ear and under the transverse sinus. A transverse incision can also be made (or a vertical incision). 2. Bone window craniotomy After drilling the skull, the bone window was enlarged with a rongeur to reveal the transverse sinus and the sigmoid sinus. The diameter of the bone window was 3 to 4 cm. 3. Dural incision The dura mater is incision and the base is connected to the sigmoid sinus. 4. Determine the relationship between facial nerve root and adjacent blood vessels Under the operating microscope, the cerebellar hemisphere was retracted by the brain plate, and the inner ear hole area was opened. The thickened arachnoid was cut open, and the small nodule of the pompon was further pulled to reveal the facial nerve and the auditory nerve root of the dorsolateral region of the pons and the bridge. Observe the relationship between facial nerve roots and adjacent blood vessels. According to statistics, the most common vessels that compress the nerve roots near the brainstem are the posterior inferior cerebellar artery and the inferior cerebellar artery, accounting for more than 80% of all compression vessels. The rare vertebral artery, basilar artery and other small arteries and the pons External drainage vein. Cerebral arteriovenous malformations and aneurysms are rare. The types of vascular compression are roughly divided into: 1 single vasospasm compression, accounting for 75% to 85%; 22 or more vascular compression accounts for 7% to 16%; 3 vascular perforation facial nerve compression accounts for 1% to 2% . 5. relieve nerve compression The thickened arachnoid is cut along the surface of the nerve root and its compression vessel, the fibrous strip between the nerve root and the compression vessel is separated, and the compression vessel is gently retracted. A suitable amount of Teflon cotton is placed between the nerve root and the compression vessel. The nerve roots are no longer stressed and the blood vessels are not angled, and the two are separated. The sign of adequate decompression of the facial nerve is that the nerve root floats freely in the lateral cerebellar pons pool of the pons. About 90% of patients had facial epiphysis disappeared during the operation, but about 10% of the patients' facial muscles were still twitching. In this case, the facial nerve root is treated with low output current, and the patient is repeatedly closed and closed until the facial muscle is paralyzed, but the eye can be closed, and the face pumping mostly disappears completely. This method can improve the curative effect. 6. Guan skull The dura mater is tightly sutured, and the lower occipital muscles and skin are sutured. complication Hearing loss It accounts for 2% to 10%, which is caused by pulling the auditory nerve during surgery. 2. Dizziness More common, also temporary, no special treatment. 3. Low intracranial pressure syndrome Handle the same as before. 4. Facial muscle paralysis 2% to 5%, more than self-recovery.

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