微血管减压术后复发性或失败性面肌痉挛的病因分析及再手术策略
Etiological analysis and reoperative strategies for recurrent or failed hemifacial spasm after microvascular decompression.
文献信息
| PMID | 42702634 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yulong Chong |
| 作者单位 | Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu, China. |
| 期刊 | Neurosurgical review |
| SCI 分区 | Q1 |
| IF | 3.2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
系统分析原发性面肌痉挛（HFS）微血管减压术（MVD）后症状复发或失败的病因，并评估基于精确病因分类的个体化再手术策略的安全性和有效性。对2009年1月至2025年12月期间由同一位外科医生治疗的72例MVD后复发或失败的患者进行回顾性分析。根据翻修术中的术中发现，将病因分为四型：I型（遗漏责任血管）、II型（血管移位或减压不充分）、III型（Teflon相关并发症：粘连/压迫）、IV型（初次手术中解剖结构误判）。根据具体病因实施个体化再手术。72例患者中，51例为症状复发，21例为症状持续。病因分布为：I型15例（20.8%）；II型34例（47.2%）；III型17例（23.6%）；IV型6例（8.3%）。再手术后，70例（97.2%）治愈，2例仍有症状。并发症包括早期和迟发性面瘫（20例）、听力下降或耳鸣（7例）、后组颅神经损伤（3例）、脑积水（2例）和迟发性颅内出血（1例）。MVD后失败是多因素结果，可系统分为四种主要类型。以该病因分类为指导的再手术策略显著提高了治疗的针对性和成功率。尽管并发症风险高于初次手术，但该方法总体安全有效，为这一临床难题提供了可靠的解决方案。
英文摘要
To systematically analyze the etiologies underlying recurrent or failed symptoms after microvascular decompression (MVD) for primary hemifacial spasm (HFS) and to evaluate the safety and efficacy of a tailored reoperative strategy based on precise etiological classification. A retrospective analysis was conducted on 72 patients who experienced recurrence or failure after MVD, all treated by the same surgeon between January 2009 and December 2025. Based on intraoperative findings during revision surgery, the causes were classified into four types: Type I (missed offending vessel), Type II (vessel migration or inadequate decompression), Type III (Teflon-related complications: adhesion/compression), and Type IV (misidentification of anatomical structures in the initial surgery). Individualized reoperations were performed according to the specific etiology. Among 72 patients, 51 had recurrent symptoms and 21 had persistent symptoms. The etiological distribution was: Type I, 15 cases (20.8%); Type II, 34 cases (47.2%); Type III, 17 cases (23.6%); and Type IV, 6 cases (8.3%). After reoperation, 70 patients (97.2%) were cured, while 2 remained symptomatic. Complications included early and delayed facial palsy (20 cases), hearing loss or tinnitus (7 cases), lower cranial nerve injury (3 cases), hydrocephalus (2 cases), and delayed intracranial hemorrhage (1 case). Failure after MVD is a multifactorial outcome that can be systematically categorized into four main types. A reoperative strategy guided by this etiological classification significantly enhances treatment specificity and success rates. Although associated with a higher risk of complications than primary surgery, this approach is overall safe and effective, providing a reliable solution for this clinical challenge.