摘要
目的探讨面肌痉挛(hemifacial spasm,HFS)微血管减压术(microvascular decompression,MVD)术后迟发性小脑出血的发生机制及预防、处理方法。方法回顾分析1例面肌痉挛MVD术后迟发性小脑出血患者的临床资料;并查阅复习面肌痉挛MVD术后继发出血的文献。结果本例患者表现为典型左侧面肌痉挛,行MVD术治疗,手术过程顺利。术后患者面肌痉挛症状完全消失,术后第2 d出现意识障碍,复查CT示小脑出血并脑积水;即行侧脑室外引流术,经积极治疗后恢复良好。结论 术中牵拉小脑组织和颈部扭曲致颈部静脉回流受阻,是MVD术后并发迟发性小脑出血的主要原因;而患者既往存在脑血管病变可增加术后小脑出血风险。尽早清除血肿并侧脑室外引流术是治疗MVD术后迟发性小脑出血的最佳措施。
Objective To explore the underlying mechanism, prevention and management of delayed intracerebellar hemorrhage following microvascular decompression(MVD) for hemifacial spasm(HFS). Methods Literature review of secondary intracranial hemorrhage following MVD for HFS, the clinical data of delayed intacerebellar hemorrhage following MVD for HFS was carefully analyzed. Results The left HFS patient with typical symptoms underwent MVD and the symptoms disappeared completely after operation. His consciousness deteriorated gradually on the second day after operation. CT showed there was intracerebellar hemorrhage and hydrocephalus. The external ventricular drainage was placed. The patient was discharged without neurological deficit. Conclusions The main causes of delayed intracerebellar hemorrhage are cerebellar retraction.The obstruction of jugular venous return is caused by cervical distortion during operation. Previous vascular disease can increase postoperative risk of intracerebellar hemorrhage for patients. Early and prompt surgical intervention for delayed intracerebellar hemorrhage is the best strategy and greatly improve the prognosis .
作者
常海刚
高国军
黄立勇
李信晓
孙涛
王峰
CHANG Hai-gang;GAO Guo-jun;HUANG Li-yong(Department of Neurosurgery,The General Hospital of Ningxia Medical University,Yinchuan 750004,China)
出处
《临床神经外科杂志》
CAS
2019年第5期443-447,共5页
Journal of Clinical Neurosurgery
基金
宁夏回族自治区重点研发计划(2018BFG02007)
关键词
面肌痉挛
微血管减压
迟发性小脑出血
hemifacial spasm
microvascular decompression
delayed intracerebellar hemorrahge
