| Part ? Discuss the neurovascular compressive mechanics phenomenon and promote a new patternPurpose Discussing the neurovascular compressive mechanics phenomenon of hemifacial spasm through MR,and to promote a new pattern combined the surgery.Metheod120 hemifacial spasm(HFS) patients were collected in Guangdong NO.2 Provincial People's Hospital undergoing microvascular decompression(MVD) from January 2014 to December 2015. The affected side as the treatment group and the unaffected side as the control group by self-control. According to MR, we observed the vertebral artery(VA)deviation, the width of cerebellopontine cistern(pon.cist) and cerebellomedullary cistern(med.cist), the existence of offending vessel and the impression in pons or medulla.All patients underwent the sigmoid sinus surgery lately to observe the offending vessels of facial root exit zone(f REZ).According to the histology,we always differed the facial nerve into four region:root exit point(Rexp),attached segment(AS),root detachment point(RDP),cisternal portion(CP).And recognizing the impression of the facial nerve to promote the concept of elasticity theory.Then promoting the new neurovascular compressive patterns and degrees.Results 1.The VA deviation to affected side was 81.7%(98/120).The VA deviation to unaffected side was 10%(12/120).The VA in symmetry was 8.3%(10/120).The two groups had statistics difference. 2.65% affected side of pon.cist was wider than the contralateral wide,31.7% in symmetry,3.3% narrower than the other side. 41.7% affected side of med.cist. was wider than the contralateral wide, 53.3% insymmetry,5% narrower than the other side. 54.2% both of two cisterns were wider than the other.The two groups had statistics difference. 3.The vessels in the wider pon.cist. of affected side was 83.3% and the vessels in the wider med.cist. was 70%. The vessels in both of them was 100%.The vessels in the wider pon.cist. of unaffected side was 25% and the vessels in the wider med.cist. was 0%. The vessels in both of them was 0%.The two groups had statistics difference. 4.The impression in pons or medulla of affected side was 66.7%,the other side was 5%.The impression depth of affected side was 8.35±1.51 mm,the other side was 4.23±1.24 mm.The two groups had statistics difference. 5.All patients had offending vessels, among them, having no impression was 1.7%,having impression was 98.3%.Rexp was 47.5%, AS was 27.1%,RDP was 15.3% and CP was 10.1%. 6.According to the surgery, grade 0 was 1.7%,grade 1 was 15%,grade 2 was 46.7%,grade 3 was 28.3% and grade 4 was 8.3%. 77.According to the surgery, no impression was 1.7%, bow type was 54.2%,VA+vessels was 44.1%. 8.In grade 0, parallel vessels was 1.7%,cross vessels was 0%.In grade 1,bow vessels was 66.7%,Y vessels was 33.3%.In grade 2,long bow vessels was 66.1%,Y vessels was 17.8%,VA+vessels was 16.1%.In grade 3,VA+one vessel was 100%.In grade 4,VA+many vessels was 100%. Conclusion1.The VA deviation was related to the affected side. 2.Most of the cistern was not symmetrical, the affected side wider than the other. 3.Most of the wider cistern had vessels. 4.Most of the pons and medulla had impressions, and most of the impressions of affected side were deeper than the other. 5.Most of the impressions were in the entry of facial nerve root. 6.Promote the new neurovascular compressive patterns and degree.Part ? The relationship between neurovascular compressive mechanics phenomenon and lateral spread response(LSR)Purpose To observing the relationship between neurovascular compressive mechanics phenomenon and LSR.Methods 120 hemifacial spasm(HFS) patients were collected in Guangdong NO.2 Provincial People's Hospital who underwent microvascular decompression(MVD) from January 2014 to December 2015.Both of them had LSR monitoring during the surgery.LSR would be recorded after opening the dura, opening the cistern, pulling the offending vessels and implanting Teflon ball. To observing the relationship between neurovascular compressive patterns and LSR.Results In?type, LSR disappeared after opening dura was 50%, opening cistern was 50%, pulling the offending vessels was 0%, implanting Teflon ball was 0%.In?type, LSR disappeared after opening dura was 0%, opening cistern was 50%, pulling the offending vessels was 50%, implanting Teflon ball was 0%.In ? type, LSR disappeared after opening dura was 0%, opening cistern was 8.9%, pulling the offending vessels was 67.9%, implanting Teflon ball was 23.2%.In ? type, LSR disappeared after opening dura was 0%, opening cistern was 0%, pulling the offending vessels was 41.2%, implanting Teflon ball was 58.8%.In?type, LSR disappeared after opening dura was 0%, opening cistern was 0%, pulling the offending vessels was 20%, implanting Teflon ball was 80%.Conclusion The time of LSR disappearance was related to the neurovascular compressive patterns. If it's?or? type, LSR would disappear after opening the dura or opening the cistern.If it's ?or?or?type,LSR would disappear after pulling the offending vessels or implanting Teflon ball. |
PDF Full Text Request